Please indicate theScholarship you are applying for:
Sister Mary Dorothea Sheehan - Professional Development
Margaret Sullivan - Research
Dorothy Clarke Scholarship - Western Australia applicants only
Have you received an ACCYPN scholarships before? Yes No
If so, please provide the names of the scholarship and year awarded.
  1. PERSONAL DETAILS

Family Name
Given Name
Address / Phone ______
Fax ______
Email ______
Are you a current member of ACCYPN?
Yes No / What year did you join ACCYPN or a previous state organisation?
______
Which State are you currently employed in? ______
Are you an Australian Citizen or Permanent Resident? Yes No
Please provide a brief description of your professional role
Please outline your contribution to ACCYPN
Please attach a your CV
  1. THE PROPOSED ACTIVITY

Please attach the following informationrelevant to the Scholarship you are applying for.
Research Scholarship
A research proposal study, no more than 5 pages, including the following:
  • Background to the study
  • Literature review
  • Significance
  • Research question/s
  • Aims and objectives of the study
  • Design and method
  • Data collection - outline how data will be collected and by whom. Please attach a copy of survey, interviews questions etc (if applicable)
  • Data analysis
  • Ethical considerations
Scoring Matrix for Research Scholarships
Criteria / Points
Quality of Research Proposal - the proposal is relevant to Professional Nursing Practice related to Children’s Health and Wellbeing / 10
Potential for Proposal to Impact on children and young people’s nursing practice / 10
Total points / 20
Professional Development Scholarship
  • A copy of the conference/seminar or course outline
  • A statement describing the activity and the objectives you wish to achieve
  • A statement outlining how your attendance at the conference/seminar or course will contribute to your professional role?
  • If you are presenting a paper/ poster please attach a copy of the abstractwith your application.
Scoring Matrix for the Professional Development Scholarship / Points
Quality of Professional Development Proposal - the proposal is relevant to Professional Nursing Practice related to Children and Young People’s Health and Wellbeing / 10
Potential for the Professional Development to impact on children and young people’s nursing practice / 10
Total points / 20
Please attach a detailed budget for the scholarship for which you are seeking funding.
Are you receiving funding from any other sources:
Yes No
If Yes, please identify the source: ______
Conditions of receiving a scholarship
  • All scholarship recipients must submit a written report and proof of scholarship/grant expenditure.
  • For professional development scholarships a report is required no later than two (2) months after attendance/completion of the conference/seminar/course.
  • Seventy percent (70%) of the grant will be paid when the grant is awarded and 30% will be paid on receipt of the report
  • For research scholarships a progress report regarding research activity funded is required twelve months from receipt of the scholarship.
  • Reports will be published on the ACCYPN website with a summary printed in the ACCYPN newsletter
  • Scholarship recipients will be required to return all scholarship monies if conditions of scholarship conditions are not completedin full.

Signature:
Date: _ _ / _ _ / _ _ _ _ / Please send signed copy with the relevant attachments to:
Australian College of Children and Young People’s Nurses
  • Email:
  • Postal address:
    The Secretary
    ACCYPN
    PO Box 206
    Wynnum Qld 4178
    Australia

Reviewed May 2015