EGA 16.0 APL Survey EGA APL 16.0 Survey Name* First Last Preferred Email (for all future correspondence)* Mobile Number (should we need to call you)*I have an accredited postgraduate qualification that matches the learning outcomes of Elizabeth Garrett Anderson modules 1-3 (gained through the 12-month Mary Seacole programme or otherwise)* Yes No I am able to secure funding to meet the subsidised programme cost of £5,000 either through my organisation or self-funding* Yes No I would need support with a bursary I can commit to all the residential dates for the seven (face to face) study days in Leeds* Yes No Residential 2 (07-09 October 2019) Residential 3 (29 April-01 May 2020) Residential 4 (25 March 2021) I am currently on an NHS employment contract which will last the full duration of the programme (minimum 18 months). I understand this is required so I can apply my learning through the work-based assignments* Yes No I am interested in receiving further application details.* Yes No