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Surgery, Anaesthesia & Critical Care Clinical Initiative Scholarship Fund

Please complete all fields marked with an *

Scholarship application form

Applicants must read and comply with the Scholarship Terms and Conditions prior to completing this form.

Applications must be received six weeks before the event for which you are seeking sponsporship.

Before you start the application please make sure you have the following:

  • Current curriculum vitae (Word or PDF format)
  • AHPRA / Orthoptic registration (PDF or image format)
  • Conference, course or program registration confirmation
  • Confirmation of manger or supervisor's approval
  • Adhered to Local Health District travel approval processes
  • Airfare and accommodation quotes if applicable
  • Employee Vendor Creation Form – Stafflink

Incomplete applications will not be accepted.

 

Which scholarship are you applying for *


Section 1: Applicant's details

DOB *
Profession *

Names of NSW hospitals and health organisations will appear as you begin typing.

Section 2: Scholarship type

Location *

Event type *
Scholarship Value table Terms and Conditions (please refer to page 3)

Section 3: Financial assistance requested

$AUD
$AUD
$AUD
$AUD
$AUD
$AUD
$AUD
$AUD

Section 4: Document upload

We require some supporting documentation for your scholarship application. Please place the following in a zip file and upload below:

  • Quotes for conference registration, travel and accommodation if applicable
  • Incomplete applications will not be accepted.

    You can read instructions for creating a zip file. Please keep your files to under 7MB in size.

    Section 5: Objectives for attending conference/course/workshop

    Section 6: Have you previously applied for a scholarship from this committee?

    Previously applied *
    Was a report submitted?

    Section 7: Have you applied for funding from any other body?

    Have you applied for funding from any other body? *

    Section 8: Employer's support

    Section 9: Declaration

    Declaration *

     

      Please click the submit button once only. This form might take a minute to submit.

    Anaesthesia Perioperative Care
    Helen Badge

    Neurosurgery
    Helen Vaz

    Gynaecological Oncology & Urology
    Violeta Sutherland

    Ophthalmology
    Helen Badge

    Blood and Marrow Transplant
    Richard Makin

    Clinical Genetics
    Sally Howard