Kaipara Project Nurse Group Rural Retention Fund Application Form for Nurses Who Are Working

Kaipara Project Nurse Group Rural Retention Fund Application Form for Nurses Who Are Working

Attention all Nurses/Midwives/Allied Health Professionals/Practice Managers and Senior Administration staff in Rural Hospitals and Rural General Practices within the Otago Region

The Otago Community Trust (OCT) is generously sponsoring up to 10people from the Otago region to attend the National Rural Health Conference in Auckland from5 – 8 April 2018.

OCT will sponsor each successful applicant with up to $1,000 incl GST to cover the cost of registration, accommodation and/or flights for the conference.Any expenses outside of this cannot be claimed.

Applicants must:

  • Be currently employed as a Nurse, Midwife, Allied Health Professional, Practice Manager or Senior Administrator in either a Rural Hospital, Rural General Practice or Primary Maternity Unit within the Otago Region
  • As a condition of accepting the scholarship applicants must agree to supplying the Trust with a report, within one month of the conclusion of the conference
  • Provide full receipts of registration, accommodation and/or flights in order to be reimbursed up to the value of $1000 incl GST.

For more information on the National Rural Health Conference 2018 please click

Application forms are available below and must be submitted to Charlotte Sloane, Conference Innovators, PO Box 7191, Sydenham, Christchurch or by email to . Applicationsshould be received no later than Monday 13 February 2018.

Successful applicants will be notified by email, no later than 5pm, Friday 17 February 2018.
Best regards from

The Otago Community Trust

APPLICATION FORM FOR THE OTAGO COMMUNITY TRUST SPONSORSHIP TO THE 2018 NATIONAL RURAL HEALTH CONFERENCE

applicants must Be currently employed as a nurse, midwife, Allied Health professional, Practice manager or a senior administrator in either a Rural Hospital, a Rural General Practice or a Primary Maternity Unit within the Otago Region

professional Category:

Rural NurseRural Allied Health Professional

Rural MidwifePractice Manager

Senior AdministratorOther…………………………….. (explain position)

Individual Information

Title:
First name:
Last name:
Contact phone:
Mobile:
Email address:
Postal address:
Physical address:
Occupation:
Employer:
Postal address (if different from above)
Contact phone (if different from above)
Email address (if different from above)

In making this application I confirm my understanding that the Otago Community Trust will sponsor the registration fee, flights and accommodation up to the value of $1,000 (GST inc) and reimbursement will be made after providing receipts of payment.

Condition of funding:, You will be required to provide a written report back to the NZRHN and the Otago Community Trust within one month of the conclusion of the conference.

STATEMENT IN SUPPORT OF YOUR APPLICATION:

  1. List the benefits to you personally if you attend this Conference
  1. List the benefits to your organisation if you attend this Conference
  1. Anticipated expenditure i.e broken down cost of registration, accommodation and flights

Signed by Applicant______

Print Name______

Date ______

PLEASE EMAIL COMPLETED APPLICATION FORM TO

Top View