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The School of Nursing and Midwifery
Application Form
The Douglas Travel Award
The School of Nursing and Midwifery at Queen’s is delighted to be able to offer undergraduate students the opportunity to obtain funding for attendance at conferences.
Background:
Often during their studies, Nursing and Midwifery students are keen to travel to conferences and meetings to broaden their knowledge base and gain new insights into their area of study. This travel fund offers £500 for one student to attend a national or international conference such as the RCN/RCM conference; this includes support for conference registration fees, travel and accommodation.
All pre-registration undergraduate students are invited to apply. To be considered for an award from this fund you must submit a detailed statement in support of your application as to why you should be considered for support and the learning outcomes you want to achieve. The final decision will be taken by the Head of School.
PLEASE COMPLETE IN BLOCK CAPITALS (BLACK INK)
Closing date for receipt of completed applications is Friday 8th January 2016.
1. PERSONAL DETAILS
Surname - / First names -Title Mr/Mrs/Miss/Ms - / Previous Surname(s) -
Date of Birth - / Email address -
Contact Telephone Numbers
Home -
Work -
Mobile - / Correspondence Address –
Postcode -
Please state:
(1) Your student card number -
(2) Your Intake & Branch -
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2. PLEASE INFORM THE PANEL HOW YOU INTEND TO USE THE FUNDING, AND WHAT YOU EXPECT TO GAIN FROM IT. Please submit a written statement, not more than 500 words, to describe why you should be considered for this award and the learning outcomes you expect to achieve.
3. DECLARATION AND SIGNATURE OF APPLICANT
I confirm that the information given on this form is true, complete and accurate. I accept that if the relevant information is inaccurate or omitted, the University reserves the right to reject my application for funding.
I authorise the University to approach Government Agencies, Educational Establishments, Former Employers and Referees for verification of application details should they be needed, and I consent to the University processing the information in this form for administrative purposes, including consideration of my application in accordance with the provisions of the Data Protection Legislation.
I understand that I will be required to submit a written report to the donor within 6 weeks of attending the conference.
SIGNATURE: / DATE:PLEASE CHECK YOUR APPLICATION CAREFULLY TO ENSURE THAT ALL SECTIONS HAVE BEEN COMPLETED.
ONCE COMPLETED, PLEASE EMAIL THIS APPLICATION TO BEFORE THE CLOSING DATE OF 4.00PM ON FRIDAY 8TH JANUARY 2016.
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