Scholarships and Grants Program

Application form

Effective February 2018

Instructions: complete the required sections and save this on your computer. Only grey fields can be typed into. Email the saved file to

Applications must be received by the closing dates of 31 January or 31 July.

Section 1 - Acceptance

I have read, understood and agree to abide by the Wounds Australia Scholarship and Grants criteria, terms and conditions

Section 2 – Scholarship or Grant Type

Charles Lucre scholarship (ACT members only)

Helen Dengate scholarship (ACT members only)

Janet Vincent scholarship (SA members only)

Jan Rice volunteer service award (Vic members only)

Sandy Dean memorial scholarship (Vic members only)

Winifred Felle education and research fund (WA members only)

ProfessionalDevelopmentGrant

Early researcher grant

Established researcher grant

NB: National Conference Attendance Award application process will be conducted separately.

Section 3 – Applicant details

If more than one member will be involved with the program (e.g. research project with multiple investigators) please only include details of the principal member involved

Preferred title
First name
Last name
Employment position
Formal qualifications
Full mailing address
Email address
Home phone
Work phone
Mobile phone
For grants and scholarships over AU $1,000 only
I have been a financial member of Wounds Australia for over three years
Only members who have held continuous membership with Wounds Australia (including AWMA) can apply for a grant or scholarship over AU $1,000.

Have you receivedaProfessionalDevelopmentGrantfromWoundsAustralia(previouslyAWMA) or any AWMA State or Territory Associationinthepasttwoyears?

No

Yes

Ifyes,pleaseprovidedetailsof the program and the amount awarded.

Section 4 – Program details

In250wordsorless,describetheintendeduseoftheGrantorScholarship. Please include date, provider, location and duration. If a flyer or further information is available this can be attached to the application or the relevant URL/link provided.

In250 wordsorless,discusshowyourchosenactivitywillassistyouinfurtheringyourcareerin woundmanagement.

In250wordsorless,discusshowyourchosenactivitywillbenefityourfellowcolleaguesandthe healthoutcomesandmanagementofyourpatients/clients.

Section 5 – For EarlyCareerResearcher orEstablishedResearcher applications only.

Selectlevelofproposedresearch:

Level1(systematicreview,meta‐analysis,RCT)

Level2(QuasiRCT,Crossover,parallel)

Level3(Casecontrol,Caseseries,Casestudy)

Provideaclinicalsynopsisofyourstudyinthetablebelow:

Aims
Objectives
Hypothesis
PopulationandSetting
Interventions
ANZCTRRegistrationNumber:
StudyDesign
Totalnumberofparticipants
Samplesizeconsiderations(#of
groups/participants)
StatisticalbasisforsamplesizeincludingHistoricaldatausedincalculation
Primarymeasuresandoutcomes
Secondarymeasuresandoutcomes
Inclusioncriteria
Exclusioncriteria
Studysite(s)

Ifthestudyis asystematicreview/meta‐analysis,implementation/technical report Pleasespecifythe methodology that will be usedandlisttheprotocolnumber(ifrelevant)

Methodology

Protocolnumber(ifapplicable)
Section 6 – Budget

Total amount applied for in Australian dollars
Coststhatwillbemetbyyouremployer
Coststhatwillbemetbyany organisationotherthan Wounds Australiaoremployer
Whatyouwillbepayingfor
Itemisedcosts (e.g. forconference registration fees, accommodation,travel)
Any other scholarshipsorsponsorshipapplied for or received
Other

Section 7 – Awarding funds

If your application is successful funds awarded will be transferred to your bank account.

Section 8 - Verification

I, (insert name) verify that I have completed this application, including all relevant sections.

THANK YOU FOR YOUR APPLICATION.

IF YOU REQUIRE ANY ADDITIONAL INFORMATION PLEASE CONTACT WOUNDS AUSTRALIA via

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