Practice Nurse Scholarship GNC program - Online EOI form

Section A - Aplicant details

Are you currently working and residing in South Eastern New South Wales? (required)

If you chose no, then you are not eligible for this scholarship. You must be currently working and residing within South Eastern NSW to apply.

We thank you for your interest and encourage you to keep an eye on our funding opportunity webpage for future opportunities.

Select the LGA(s) you are currently working / residing in? (required)

If you chose other, please confirm what LGA you are currently working/residing in. (required)

Eligibility - I confirm I meet the eligibility criteria as outlined in section 3 of the EOI Guidelines (required)

Applicant name (required)

Mobile phone (required)

This is a numeric field. Only numbers can be submitted

Email (required)

GP practice or place of work (required)

GP practice address or place of work address (required)

Position / title (required)

Professional body / membership number (i.e. provide membership accreditation number such as an AHPRA number etc.) (required)

ABN/GST registration (select one of the options) (required)

ABN number (required)

Section B - Aplicant responses

1. Outline your interest in participating in GNCs Program, including your motivation for pursuing this opportunity. Please include how you will accommodate compulsory attendance at the online workshops which occur during business hours and if you have the support of your practice - 40% (max 500 words)

(required)

2. Describe how participating in the GNCs program will enhance your ability to provide high-quality care to older adults. In your response, reflect on your current practice and how you plan to apply your learnings in your future nursing role – 40% (max 500 words)

(required)

3. What do you see as the most pressing challenge in caring for older adults, and how would completing the GNCs program help you address this challenge in your nursing practice – 20% (max 500 words)

(required)

Section C - Declaration

This must be completed by the individual submitting the application:

I agree that I understand the course commitment and am able to participate in all workshop sessions and complete the required obligation under Scholarship agreement (Appendix 1). (required)

I agree to share my experience of participating in the GNC Program. This may take the form of an informal presentation and Q&A (20-30 mins) to the COORDINARE HCCs, participation in an interview, or by writing an article for a COORDINARE newsletter. (required)

If selected as the successful applicant, I agree to the terms and conditions outlined in the draft Scholarship Agreement. (required)

I understand and accept that information provided in this application may be stored by COORDINARE – South Eastern NSW PHN in various hardcopy and/or electronic formats. (required)

I understands that if the conditions of the funding are not complied with, COORDINARE – South Eastern NSW PHN may seek to recover any funds allocated. (required)

I can confirm that the contents of this application are to the best of my knowledge accurate, complete and do not contain any false, misleading or deceptive misrepresentation, claims or statements. (required)

I understand that if the conditions of the funding are not complied with, COORDINARE – South Eastern NSW PHN may seek to recover any funds allocated. (required)

Applicant signature

Full name (required)

Date (required)

How did you hear about this opportunity? (required)