ILM Level 5 in Coaching and Mentoring Application Form

It’s great you want to develop yourself on our ILM 5 Certificate in Effective Coaching and Mentoring.

Before you get going on the application form there are a few things that we will need you to check first:

(a) Double check if you have the capacity to meet the demands of the programme schedule, then provisionally add the first five programme dates of the cohort you would like to attend to your diary so that this time is clearly set aside.

This does not guarantee you will be accepted onto the programme, but does mean (if you are accepted) that you have the initial time and organisational support to attend.

(b) Check whether you are from a West Midlands Coaching and Mentoring Pool Subscribing Organisation - you will need to provide some supporting information and endorsement from your organisational representative. Please request a Supporting Information Form from info@wmemployers.org.uk if you require this.

(c) If you are from a subscribing organisation and would like to join the pool following completion of the qualification you will need to confirm endorsement from your organisational representative – and submit this in in the form of a short written statement.

If you are unsure who your organisational representative is please contact email info@wmemployers.org.uk.

(d) If not paying by credit/debit card then you will need to Raise a Purchase Order made out to West Midlands Employers, JQ Modern, 120 Vyse Street, Birmingham B18 6NF.

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* 1. Please select the course you would like to attend

Cohort 3 - September 2024

Cohort 4 - February 2025

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* 2. I am joining this training in order to (select all that apply)

Become part of the West Midlands Coaching and Mentoring Pool – to coach/mentor externally to my organisation

Become part of my organisation's internal coaching and mentoring pool

Develop myself personally

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* 3. Delegate Details (Please note - the address you provide will be used to register you with ILM and send your certificate - this can be a home or work address:

First & Last Name
As you would like it to appear on your certificate

Date of Birth (dd/mm/yy)
This will be used to register you with ILM

Organisation

Postal Address

Email Address

Phone Number

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* 4. Please state any specific dietary, audio, visual or access requirements to cater for during the training

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* 5. Please outline the support you have from your organisation to complete the programme

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* 6. Joining the West Midlands Coaching & Mentoring Pool (WMCMP) The WMCMP gives you the opportunity to put your new skills into practice but it also requires additional commitment following the programme. If you are intending to join, please request a Supporting Information Form by emailing info@wmemployers.org.uk and then upload it here.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 7. Fees:

I am from a WMCMP subscribing organisation: £1,730 + VAT (£2,076)

I am from a WME Member organisation: £1,820.00 + VAT (£2,184)

I am from a Non subscribing organisation: £2,180 + VAT (£2,616)

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* 8. Payment Information:

I would want to pay by Credit/Debit Card

I would want to be invoiced

Please provide the Name and Phone number of the person making the payment. If you require an invoice please include the Purchase Order Number and Invoice address here:

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* 9. Gender:

Female

Male

Intersex

Non-Binary

Prefer not to say

What are your pronouns? (e.g. She/her; He/him; They/Them; Prefer not to say)

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* 10. What is your ethnicity? (Ethnic origin is not about nationality, place of birth or citizenship. Tick the group to which you perceive you belong)

African, Caribbean or Black British

Asian or Asian British

White

Mixed or Multiple ethnic groups

Another ethnic group

Prefer not to say

*Here you can share your own description

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* 11. Do you consider yourself to have a disability or health condition?

Yes

Prefer not to say

This information is for monitoring purposes only.

Please help us understand if there is anything that we can do to help support you and create the best learning environment for you?

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* 12. Are you Neurodivergent?

Yes

Prefer not to say

This information is for monitoring purposes only.

Please help us understand if there is anything that we can do to help support you and create the best learning environment for you?

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* 13. Managing Your Information

Managing Your Information revised below

1. I accept that my details will be shared with West Midlands Employers (Co-ordinator for the West Midlands Coaching and Mentoring Pool); The Development Partnership (Programme Facilitators and Associates marking the assignments) and ILM (Accredited Body).

2. I have read and understand the WME General Privacy Notice and the Event & Training Bookings Privacy Notice which outlines how my personal data will be managed.

Yes, I have read and accepted the above use of my information

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* 14. From time to time we would like to email you information about our Events and Services that we think may be of interest to you. If you are happy to receive this information please tick the box below.

I would like to receive emails from WME informing me of other Events and Services

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* 15. General Information:

1. If the wrong delegate type is chosen and a change in pricing is the result then we will advise the person responsible for making the booking of this change in fee.

2. We will email confirmation of your place following the application deadline or earlier if possible.

3. Places will be prioritised for WMCMP Subscribing Organisations who need to increase their contribution to the pool.

Cancellation Policy:
By submitting this application, you are confirming that you can attend all of the dates for the cohort that you have selected.

1. If you cancel your place 4 weeks or less prior to the start of the programme, then 100% fee per delegate is payable.

2. All cancellations should be in writing to info@wmemployers.org.uk.

Yes, I accept the terms and conditions