Pelvic, Obstetric and Gynaecological Physiotherapists

www.pogp.org.uk

Application for funding from the Dame Josephine Barnes Bursary

Closing dates: January 1 st or July 1st each year

Please answer ALL the following questions

PERSONAL DETAILS
Name
Address
Postcode
Tel. No
Email
Qualifications
Current working position held
CSP number
POGP number
How long have you been a member of POGP?

1. Please give details of the course/research project that you are applying for:

If the application is for a research project/poster presentation or paper, please attach a proposal including title, brief abstract of project, background and purpose, plan of investigation, plans for data analysis, proposed timetable and budget. In addition, please include details of supervisors or mentors supporting the project.

2. Please state the relevance of this project to women’s health including the proposed benefit to both the patient and the Association


3. Please show evidence of commitment to completing proposed course/research project and reasons why POGP should consider your application.

-  How relevant is this to your career development and future CPD?

4. Please list recent conferences/courses attended and invitations to lecture, both

of which should be relevant to women’s health

5. Please give details of any funding:

FUNDING
Have you sought funding from any other source? If yes, please specify source and amount received
Is your employer making any contribution? If yes, please specify amount and also any paid/ unpaid study leave
Have you sought funding from POGP before? If yes, please specify when, amount and for what funding was received?

6. If successful, would you agree to write a review/summary for the ACPWH Journal if requested? Yes/ No

7. Please itemize anticipated expenses:

COURSE / Amount
Course Fees
Travel
Subsistence
Books, materials
Other
RESEARCH PROJECT / Amount
Registration fees
Budget (e.g. equipment, sundries, costs for time away from paid employment)
Other

8. Please state amount requested from POGP:______

Completed forms and curriculum vitae should be returned to the chairman by email by January 1st or July 1st each year.