SOCIETY FOR THE STUDY OF ADDICTION

APPLICATION FOR A BURSARY TO ATTEND AN EDUCATIONAL COURSE

PLEASE NOTE THAT THE BURSARY BUDGET IS LIMITED. APPLICANTS MUST CONFIRM THAT THEY HAVE SOUGHT FUNDING FROM THEIR EMPLOYER AND BEEN UNABLE TO OBTAIN FUNDS BEFORE APPLYING FOR A BURSARY.

ALL QUESTIONS MUST BE ANSWERED, EVEN WHERE NEGATIVE. INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED.

CONSIDERATION FORANAWARD OF A BURSARY IS CONTINGENT UPON CLEAR AND FULSOME ANSWERS. UNCLEAR, UNCONSIDERED, RUSHED OR PARTIAL RESPONSES ARE LIKELY TO BE REJECTED.

ARE YOU USING THE LATEST VERSION OF THIS FORM? OLDER VERSIONS CANNOT BE CONSIDERED – CHECK WEBSITE BEFORE SUBMITTING

YOUR DETAILS

Name: / Click here to enter text. /
Address: / Click here to enter text. /
Post code: / Click here to enter text. /
Email address: / Click here to enter text. /
Tel. no.: / Home: / Click here to enter text. /
Work: / Click here to enter text. /
Qualifications you have already obtained: / Click here to enter text. /
Present employer or voluntary organisation - name and address: / Click here to enter text. /
Employer/voluntary organisation’s website address: / Click here to enter text. /
Your position is: / Choose an item. /
Your job title: / Click here to enter text. /
Name and address of your line manager: / Click here to enter text. /

YOUR PAST EXPERIENCE

Please summarise your experience of working in the addictions field and your intended commitment to the addictions field (max. 250 words):

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Have you attended a course within the last twelve months? (If Yes, please give details and state if you received funding for this training.)
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Please summarise in the space below the most recent of any studies undertaken when in receipt of an SSA bursary:
Start date(month year): / Click here to enter a date. / End date(month year): / Click here to enter a date. /
Course name:
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Institution providing course:
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Level of study (eg, Diploma, Certificate, Module or other):
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Outcome (eg, pass level/fail/unable to complete):
(The outcome of any previous modules/components of this course must be provided in your application. Applications submitted without this information will be declined, so please do not submit until you have the outcome.)
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YOUR INTENDED STUDY

Please give details of the qualification you are studying for.
Title of the course you wish to attend:
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Level of the course you wish to attend:
(eg - MSc; Foundation degree; BSc or equivalent; Diploma; Certificate in Education; Stand alone module; or Other -give details)
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Number of credits you will be studying for during the period of the bursary: / Click here to enter text. /
During THIS year's study activity, will you be taking: / Choose an item. /
Name of the educational institution validating the course:
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Location where the course is held:
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Name of course co-ordinator: / Click here to enter text. /
Email address of course co-ordinator: / Click here to enter text. /
Is the course: Taught (face to face); Distance learning; or Blended learning? / Choose an item. /
Is it full-time or part-time? / Choose an item. /
Number of taught hours of study per week? / Click here to enter text. /
Duration of study for which the bursary is requested:
(Awards are made for one study year only and must be applied for separately in subsequent years.) / Click here to enter text. /
Cost of the period of study for which the bursary is requested: / Click here to enter text. /
Duration of study for the full qualification: / Click here to enter text. /
Cost of the full qualification: / Click here to enter text. /
Date of proposed commencement of the element for which the bursary is sought(month & year):
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Date of expected completion of this element(month & year):
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Date of commencement of the whole course of study if more than one year(month & year):
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Date of anticipated completion of the whole course of study if more than one year(month & year):
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REASONS FOR PROPOSED STUDY
How would your attendance at the course benefit the patients/clients with whom you work (max. 100 words):
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How would your attendance at the course benefityour organisation (max. 100 words):
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YOUR FUNDING SITUATION

Have you applied to any other source for funding? / Choose an item. /
Body or organisation applied to: / Click here to enter text. /
Amount granted: / Click here to enter text. /
Please state what funding is available from your employing body;
For course fees: / Click here to enter text. /
For travel or other expenses: / Click here to enter text. /
Signature: / Click here to enter text. /
Date: / Click here to enter a date.
As part of receiving a bursary I would like to become an Associate of the SSA for the duration of my bursary
[Annual fee of £25 will be paid by the SSA on behalf of bursary recipients.] / Choose an item. /
*Please note, submitting this application confirms applicants’ acceptance that bursaries are awarded on the basis that the recipient will complete the period of study being funded, including the formal course assessment(s), and will repay to the Society the awarded sum in full if a final assessment is not completed at the end of the period specified in the application. Students are required to submit to the Society without delay a photocopy of their completion certificate.
Please return this form FAO Dr Daphne Rumball,
as an email attachment to:
or
Please send by posta signed letter from your Line Manager to confirm organisational support of the proposed study activity.
This is essential to the processing of the application. The letter of support should not be longer than one side of A4, must be on headed paper, and bear the employer/volunteer supervisor’s original signature. It must cover the following three areas:
  1. The applicant’s ability to study at the required level, to work hard and complete the course.
  2. The support of the employing organisation for the required time for course attendance and related studies.
  3. A statement on any funding available, with specific amounts OR a statement if no local funding is available.
Applications cannot be considered until this letter is received.
Please send the supporting letter to:
SSA Bursary Administration, Executive Office, 19 Springfield Mount, Leeds, LS2 9NG
* Please use this box to tell us about any items that you were not able to complete using the drop-down menus:
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The Society for the Study of Addiction is a registered charity no. 1009826, and a company limited by guarantee registered in England, no. 02691654. Registered Office: Leeds Addiction Unit, 19 Springfield Mount, Leeds, LS2 9NG