ASHHNA / CSL Biotherapies
Carol Martin Professional Development Scholarship
For Sexual & Reproductive Health and HIV Nurses
Sponsored by ViiV Healthcare
Closing date for applications: 26th May 2017
Successful applicant/s notified: 14th July 2017
Introduction
ASHHNA Inc. (ASHHNA) is committed to supporting the professional development of nurses working in sexual & reproductive health and HIV.
The scholarship has been named in honour of our friend, colleague and ASHHNA Vice-President, Carol Martin who passed away in February 2011. Born and trained in Scotland, Carol nursed in Dubai, Abu Dhabi and the Cameroons before moving to Australia, where she worked at Albion St Centre. Most recently she worked as Clinical Nurse Consultant at Clinic 16, RoyalNorthShoreHospital in Sydney, and Technical Advisor on the PNG Australia Sexual Health Improvement Program. Carol was a passionate and skilled clinical nurse and educator who was involved in the education and training of many HIV and sexual and reproductive health nurses and doctors. Carol's legacy will continue through the inspiration and influence she had on all those who worked with her and knew her.
Aims of the scholarship
- To recognise the significant input into sexual & reproductive health and HIV made by Australasian nurses.
- To encourage further education and professional development for sexual & reproductive health and HIV nurses.
- To encourage nurses to undertake research in the area of sexual & reproductive health and/or HIV.
- To encourage nurses to present and attend relevant sexual & reproductive health and/or HIV conferences.
Applicant criteria
The applicant must:
- Be a current financial member of ASHHNA. Full, life and associate members are eligible to apply.
- Provide proof of current registration as a nurse and/or midwife with the appropriate registration body(e.g. The Australian Health Practitioner Regulation Agency [AHPRA], TheNursing Council of New Zealand[NCNZ]).
- Have not received an ASHHNA professional development scholarship in the previous three years.
- Submit atypedapplication on the current official application form and send it electronicallyto the Scholarship Coordinator.
- Ensure the application (including resubmissions) is received by the end of business on the closing date. Applications received after this date will not be eligible for consideration.
- Provide details of the proposed educational course or conference, and justification of how this program will be of direct benefit to themselves, and sexual & reproductive health and/or HIV nursing.
- Provide proof of acceptance into the educational course or conference (where applicable).
- Provide evidence of Research Ethics Committee approval for research (where applicable).
- Provide details (including amounts) of other sources of funding applied for or received for the educational course, conference or research.
- Use the scholarship funds for the purpose as deemed by the ASHHNA Executive Committee.
Conditions of Funding
Scholarship recipients are required to:
- Notify the ASHHNA Executive Committee if funds are sought and/or received from another source. If funding is received from other sources, that cover necessary expenses, applicants should return the scholarship to ASHHNA within four (4) weeks.
- Notify the ASHHNA Inc. Executive Committee if unable to attend the educational course or conference, or if the course, conference or research is cancelled. In this instance, the funding must be returned to the ASHHNA Executive Committee within four (4) weeks of the cancellation or non attendance.
- Provide ASHHNA with a report on the research undertaken, or the course or conference attended within one (1) month of completion of the program. The report will remain the property of ASHHNA and will be published in the ASHHNA Newsletter and on the ASHHNA website.
- In the case of research not completed within 12 months of receiving the scholarship; submit an interim report.
Incomplete applications may not be considered for funding.
Funds are made available on a merit or needs basis. The ASHHNA Executive utilise specific criteria for applicant selection and the decision of the ASHHNA Executive Committee on the allocation of funds is final.
If the recipient fails to observe the conditions of the scholarship, the scholarship may be suspended or terminated at any time, at the request of the recipient or the ASHHNA Executive Committee.
All ASHHNA members are encouraged to apply for the scholarship. Membership of more than 12 months may be used as a additional assessment criteria.
Payment of Scholarship
Successful applicant/s will be informed by the nominated date and their names will be published in the ASHHNA Inc. Newsletter and on the ASHHNA website.
Cheques are made payable to the educational provider conducting the course, the conference organisers, or the organisation supporting the research. The funds can be made payable to scholarship recipients when ASHHNA receives the original receipt for costs incurred. When the employer or sponsoring organisation has paid any costs, cheques will be made payable to the employer or sponsoring organisation.
For further information
please contact the ASHHNA Scholarship Coordinator:
Suzanne Wallis
Ph: (03) 5823 7925
Mob: 0427 564 512
2017Carol Martin Professional Development Scholarship
For Sexual & Reproductive Health and HIV Nurses
Sponsored by ViiV Healthcare
APPLICATION FORM
Please type details in the space provided, do not handwrite.
Personal Details
Surname:
Other Names:
Address:
Postcode:
E-mail:
Telephone:
Fax:
Employer Details (if employed)
Employer:
Position held:
Address:
Telephone:
Fax:
PURPOSE OF SCHOLARSHIP APPLICATION
To fund:
Conference attendance as presenter
Conference attendance as delegate
Further education
Research
Other
SECTION A - All applicants must complete this section
A1. Describe in detail how this course/conference/research will enhance and develop you as a Sexual & Reproductive Health or HIV Nurse and contribute to nursing through ASHHNA. (Attach separate sheet)
A2. Please provide full details of any other funding, grants or sponsorships applied for or received in relation to this application:
Name of grantor/sponsor / Amount sought / Amount grantedA3. Compete if study or conference leave is required from your employer or sponsoring organisation:
I hereby confirm that I have obtained endorsement from my employer to attend the proposed educational course/conference. Mark box with “X” if applicable.
A4. Applicant electronic signature
I hereby agree to abide by the conditions and guidelines of the Carol Martin Professional Development Scholarship for Sexual & ReproductiveHealth and HIV Nurses Sponsored by ViiV Healthcare as determined by the ASHHNA Executive Committee. The Executive Committee’s decision is final.
Name:
Position:
Date:
Place an ‘X’ in the “Agreement” box below to indicate that you have read this application form and filled it in completely and that you certify all items as above.
Agreement
Date:
Complete only one of the following sections
B – Conference attendance or
C – Further education or
D - Research
SECTION B - Conference attendance
B1. Name of conference you wish to attend:
B2. Dates of conference (inclusive):
Have you registered? Yes No
Have you paid fees? Yes No
Have you submitted an abstract Yes No
to present a paper or poster?
B3. Budget
Conference fees:$
Travel: $
Accommodation: $
Other: $
Please specify
Total amount requested: $
B4. Essential information checklist
Attached abstract (if applicable)
Attached copy of conference details
Attached conference registration form
Proof of abstract acceptance at conference (if applicable)
Attached receipts (if applicable) OR
Attached proof/quote of accommodation and travel costs
SECTION C - Further Education
Please note: Preference for scholarship funding will be given to workshop/ seminar education over tertiary courses
C1. Name of educational course you wish to undertake:
C2. Educational institution:
Address:
Telephone:
Fax:
C3. Dates of educational course (inclusive)
Have you registered/enrolled? Yes No
Have you paid fees? Yes No
C4. Budget
Course fees:$
Travel: $
Accommodation: $
Other: $
Please specify
Total amount requested: $
C5. Essential information checklist
Attached copy of course aims and objectives
Attached course application form
Proof of acceptance into the educational course
Attached receipts (if applicable) OR
Attached proof/quote of accommodation and travel costs
SECTION D - Research
D1. At what institution will the project be undertaken?
D2. Date of commencement:
Projected date of completion.
D3. What is the title of the research project you are currently completing or planning to undertake?
D4. Provide a research proposal outline including objectives, method, expected outcome and evaluation of theresearch project. (Attach separate sheet)
D5. What is the relevance of this project to sexual health and/ or reproductive health and/ or HIV nursing? (Attach separate sheet)
D6. Has ethics approval been obtained for this research project?YesNo
Attach evidence that the project has been submitted for approval to the appropriate ethics committee and that approval has been granted
.
D7. Budget breakdown
Submission of all details of planned expenditure is required.
Please note that funding will not be provided for the purchase of medical equipment.
(Attach separate sheet)
Total amount requested $
D8. Essential information checklist
Attached research proposal outline
Attached summary of research relevance to nursing speciality
Attached copy of ethics approval form relevant organisation/s
Attached budget
Attached receipts (if applicable)
SECTION E
All applicants must complete this section
Applications must be made on the official application form.
Applicant Requirements Checklist
Current copy/proof of nursing registration attached.Yes No
Are you a current financial ASHHNA Inc. member? Yes No
Have you been an ASHHNA member for more than 12 months?Yes No
Have you received an ASHHNA Inc. scholarship previously? Yes No
If yes, what year?
Description of how scholarship will enhance and develop Yes No
nursing practice and contribute to the sexual, reproductive
/HIV nursing specialty
Electronically signed Section AYes No
Relevant Section (B, C or D) information andYes No
checklists attached
Information about additional sources of funding applied for Yes N/A
or received
Endorsement from employer or sponsoring organisation for Yes N/A
study/conference leave.
Applications to be forwarded via emailto the ASHHNA Scholarship Coordinator:
Suzanne Wallis
Ph: (03) 5823 7925
Mob: 0427 564 512
and please also send a copy to mailto:
Closing date Fri 26 May 2017.
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