NORMA N. GILL FOUNDATION
CONGRESS TRAVEL SCHOLARSHIP (CTS) APPLICATION
FOR 2018 WCET™ CONGRESS IN KUALA LUMPUR – MALAYSIA
Information for applicants. Please read before completing the form.
§ Applications will be subjected to review by the NNGF™ Committee
§ The closing date for 2018 CTS applications is November 30th 2017.
§ Applications recieved after this date will not be considered.
§ Applicants will be notified by March 1th 2018.
§ There is a limited number of CTS available, therefore not all CTS applications will be funded.
§ For this 2018 congress, applicants from Southeast Asia which fulfil the criteria will be favored.
§ The amount awarded is at the discretion of the NNGF™ Committee, this may be:
A. Full CTS scholarship which includes: congress registration, congress dinner, 5 nights accomodation at NNGF™ nominated/ provided hotel/ hostel (this will be prebooked by NNGF™) and the travel allowance not exceeding USD 1500 toward economy airfares.
B. Partial scholarship which includes: congress registration, congress dinner, 5 nights accomodation at NNGF™ nominated/ provided hotel/ hostel (this will be prebooked by NNGF™) and the travel allowance not exceeding USD 1000 toward economy airfares.
C. Partial scholarship which includes: congress registration, congress dinner, 5 nights accomodation at NNGF™ nominated/ provided hotel/ hostel (this will be prebooked by NNGF) only.
§ Applicants are encouraged to apply for funding from additional sources other than NNGF™, evidence of this is requested and enhances your application to NNGF™.
§ Previous recipients of Congress Travel Scholarships are not eligible for year after prevous award. Please do not apply if you received a full or partial congress travel scholarship in 2014 or 2016. This will be checked against WCET™/ NNGF™ Scholarship record.
§ Preference will be given to applicants who can show an evidence for submitting an abstract for this congress and those who can demonstrate that they are active in the WCET™ on a committee, editorial board, advisory panel or ID.
Essential Eligibility Criteria:
§ Member of WCET™ for 2 years prior to this application (this will be checked by WCET™ Administration)
§ Submitted all requested document with the application
§ Applicants must have:
- Have completed a WCET™ recognized education program (ETNEP/ REP) or
- Have another qualification in stoma wound and continence nursing or
- Having responsbility for ET nursing within your hospital/community or
- Have a spesific interest in developing ET nursing within your country
This completed application form must be accompanied with:
A. □ Certified copy of your nursing qualification
B. □ Documentation confirming that you have:
a. Have completed WCET™ recognized ETNEP or REP or
b. Have another qualification in stoma wound and continence nursing or
c. Having responsibility for ET nursing within your hospital/community or
d. Have a specific interest in developing ET nursing within your country
C. □ Documentation from your employer that they support your CTS application
D. □ Documentation of any evidence of applying for financial assisstant from another source
E. □ Completed signed NNGF™ Scholarship agreement form
F. □ A personal/ professional profile not exceeding 250 words detailing how this CTS will benefit yourself, your organization and your community. Include in your profile your current and or past involment in WCET™ or local ET professional organization in your city or country if applicable.
G. □ Documentation of estimated travel cost
H. □ Evidence of abstract submission documentation (if applicable)
Please submit all by email to or
Or via priority or registered mail to:
WCET™
c/o Jennifer Bank, WCET™ Director of Administration
1000 Potomac Street NW
Suite 108
Washington, DC 20007
United State of America
CONGRESS TRAVEL SCHOLARSHIP 2018
WCET™ CONGRESS KUALA LUMPUR
APPLICATION FORM
Applicant information:
1. Full Name:
2. Tittle Mr. Mrs Ms Miss Dr
3. Date of birth
4. Email address (for WCET™/ NNGF™ correspondence)
5. Telephone (including country and area code)
6. Full postal address:
7. Employment
a. Current position
b. Employer name
c. Employer address
d. Employer contact email address
8. Qualification(s)
Name od degree/ diploma/ certificate / Name of institution / Year Completed9. Detail (s) of other source of funding you have acquired or applied for: please note. Even if your request for funding from other source has not been successfull, your application for this enhances your NNGF™/ CTS application. Please document event items such as paid study/ conference leave from your employer.
Source / Amount / Details(Indicate currency USD, GBP, etc)
Employer
Hospital/ University
Cancer Society
ET Nursing association (local or national)
Ostomy Association
Charity organization (e.g Lion, Rotary etc)
Industry (specify)
Other (specify)
10. Detail of expenses
Total expense / Amount in local currency / Amount in US DolarTravel (economy class round trip): / Air
Rail
Road
Passport/ Visa fees
Early Bird Registration Congress
Accommodation at congress x 5 nights
Other expenses (specify)
TOTAL EXPENSE
Other financial assisstance obtained:
(refer to question no 10)
Total amount requested for NNGF™ Scholarship:
CONGRESS TRAVEL SCHOLARSHIP
AGREEMENT FORM
I, , (print name) hereby agree to the following conditions if I am awarded a WCET™ CONGRESS TRAVEL SCHOLARSHIP
a. I affirm that I meet NNGF™ Congress Travel Scholarship criteria and that I have not received such funding within the past six years
b. In the event I am unable to attend the congress after receiving NNGF™ Congress Travel Scholarsip Award, all money awarded to me will be returned to Norma N. Gill Foundation™ (NNGF™).
c. I am aware that NNGF™ will pay the congress registration fees and the accomodation fees direct to the congress organizer/ hotel
d. The CTS award with my name and country will be aknowledged in WCET™ Journal and other WCET™ promotional materials.
Signature:
Date: