ALLIED HEALTH ASSISTANT SCHOLARSHIP PROGRAM 2017
Application FormThe HETI Allied Health Assistant Scholarship Program provides funding to LHDs and SHNs to support the training of Allied Health Assistants (AHAs) seeking to further develop their knowledge and skills through completion of either the Certificate IV in Allied Health Assistance or the Certificate IV in Hospital/ Health Services Pharmacy Support. Eligible AHAs are able to apply for one-off funding of up to $3000 for payments for enrolment in Certificate IV AHA and Pharmacy assistant courses, skill sets or units of competency, which will enhance their ability to perform their current role. It is expected that these payments will be provided to support the balance of enrolment fees payable, once any other training funding has been explored.
SUBMITTING AN APPLICATION / ENQUIRIESBefore submitting your application, please ensure you have:
ü Read the Terms and Conditions of the program
ü Completed all parts of this application form
ü Obtained all necessary signatures from designated people
To submit the application, email the completed and signed application form to:
Applications must be received by COB on Monday 25 September 2017
Applicants will receive email notification of receipt following submission of application. Late or incomplete applications will not be presented to the Review Committee / Sue Aldrich
' (02) 9844 6571
*
APPLICANTS DETAILS
Name:
Position:
Organisation:
Work Address:
Work Telephone:
Work Email Address:
ELIGIBILITY CRITERIA
To be eligible to apply for the grant, applications must meet ALL of the following criteria:
1. The applicant is working as an AHA or following training would work, under the supervision of an allied health professional(s) in one or more of the following allied health areas:
Occupational therapy / Physiotherapy / Pharmacy
Dietetics / Speech pathology / Podiatry
Social Work
Recreation Therapy / Radiography / Audiology
2. The applicant is permanently employed by NSW Health.
3. The applicant is seeking to enrol in a full or partial qualification from the Certificate IV in Allied Health Assistance or the Certificate IV in Hospital/Health Services Pharmacy Support. This includes skill sets and individual units of competency from either of these qualifications.
4. The applicant is supported by their line manager.
5. The nomination is supported by the Allied Health Director or Director of Pharmacy of the LHD/SHN.
Applicants must demonstrate that the training is relevant to their current or planned role within NSW Health through addressing the selection criteria.
SELECTION CRITERIA
Each eligible application will be assessed on merit and quality by the application review committee against the following selection criteria:
1. Description of the proposed training including timeframe for commencement and completion.
2. Description of the need for and relevance of this training for the applicant’s current or planned role.
3. Evidence that other training funding options have been explored.
4. A quote from the RTO that the applicant would use to complete this training.
HOW THE APPLICANT MEETS ELIGIBILITY CRITERIA
1. Allied Health Assistant working/will work in the following Allied Health area/s / ☐Occupational Therapy
☐Physiotherapy
☐Pharmacy
☐Speech Pathology
☐Radiography / ☐Podiatry
☐Social work
☐Dietetics
☐Audiology
☐Recreation
Therapy
2. Is applicant a permanent employee of NSW Health? / ☐ Yes
☐ No
3. Name of qualification or partial qualification that funding is requested
4. Is the nomination supported by the line manager? / ☐ Yes
☐ No
5. Is the nomination supported by the LHD/SHN Allied Health Director or Director of Pharmacy? / ☐ Yes
☐ No
SELECTION CRITERIA STATEMENTS
1. Please describe the proposed training activity.
Include timeframe for commencement and completion.
2. Explain the need for and relevance of this training with respect to the applicant’s current or planned future role.
3. Please describe the other funding options that have been explored.
4. Please provide the name and contact details of the Registered Training Organisation (RTO) that you are planning to enrol with to complete this training.
Include the cost quoted by this RTO.
LINE MANAGER ENDORSEMENT
The Direct Supervisor
Name:
Designation:
Email Address:
Signature:
(Print off and sign) /
Date: / / 2017
COST CENTRE MANAGER ENDORSEMENT
If successful, grant funds will be transferred into a NSW Health cost centre. For this to occur, an intra-health invoice will need to be raised by the cost centre manager by COB on Friday 1 December 2017, following notification of successful application. Please nominate a cost centre for the funds to be transferred to.
Cost centre number:
Name of cost centre manager:
Email address:
Telephone number:
Signature of cost centre manager:
(Print off and sign) / Date: / / 2017
DIRECTOR OF ALLIED HEALTH ENDORSEMENT
The Director of Allied Health or Director of Pharmacy
Name:
Designation:
Email Address:
Signature:
(Print off and sign) /
Date: / / 2017
APPLICANT DECLARATION
I, as the applicant, declare that the information I have provided in this application is, to the best of my knowledge, true and accurate. I confirm that I:
1) Have sought approval for completing this qualification from my line manager.
2) Have read and understand the Allied Health Assistant Scholarship program Terms and Conditions.
3) Agree to fulfil the requirements set out in the Allied Health Assistant Scholarship program Terms and Conditions.
4) Will notify HETI if the granted funding and the proposed training is not able to take place.
5) Have attached a copy of the quote for training from the RTO.
Print and sign this document.
______ / ______ / ______
Name / Signature / Date
Please print off application, obtain required signatures,
then scan and send to