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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 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

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:

  • Current curriculum vitae (Word or PDF format)
  • AHPRA registration (PDF or image format)
  • Conference, course or program registration confirmation
  • 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.

    Neurosurgery
    Helen Vaz