Nursing and Allied Health Scholarship and

Support Scheme

Postgraduate Scholarships

An Australian Government initiative aimed at assisting Nursing

Professionals in furthering their careers in their chosen speciality.

Application Form

Closing Date for Applications:

Friday 1 October 2010

RCNA, Australia’s peak professional nursing organisation, is proud to partner the

Australian Government as the fund administrator for this program.
If you require further information or require assistance to complete your Application
Form please contact Royal College of Nursing, Australia (RCNA).
Free call: 1800 117 262
Email: scholarships@rcna.org.au

ELIGIBILITY

Funding under this scheme is available for applicants who meet the following criteria:

• Australian citizen or permanent resident

• Holds a current practising certificate
• Participating in an accredited postgraduate tertiary level course

SELECTION CRITERIA

Scholarships will be awarded on the recommendation of a selection committee who will

assess applications against selection criteria which will include your responses to the
following:

• How the scholarship will benefit you in furthering your career

• Commitment to clinical practice in your chosen professional field
• How life experiences and/or professional career to date demonstrates
your commitment to furthering your nursing career.

GENERAL INFORMATION REGARDING FUNDING

Funding will be available for full time students for up to $15,000 per year (for up to two
(2) years) during their postgraduate professional studies. Part time students will receive
up to $7,500 per year (for up to four (4) years). These funds are a contribution towards
the cost of study incurred by the student.

APPLICATION PROCESS

Scholarships will be awarded on the basis of your responses to the questions in this
Application Form.

Applications must be submitted to RCNA on or before the advertised closing date.

Unsuccessful applicants may reapply the following year should they continue to meet the
eligibility criteria.

RCNA and the Australian Government Department of Health and Ageing reserve the right
to suspend amend or vary the guidelines, the scholarship application process or any part
thereof.

LATE APPLICATIONS

Late applications will not be accepted.

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IMPORTANT INFORMATION

Only the information you provide on this Application Form will be considered.

Applicants must answer all questions in the space provided on the Application Form as
incomplete applications will not be considered for selection
This Application Form is only to be used to apply for the scholarship scheme and is not
an application to an educational institution. You must contact an educational institution
for details on how to organise your enrolment in a post graduate program. .

GENERAL INFORMATION ABOUT THE SCHOLARSHIP SCHEME

Scholarship Agreement

Scholarship recipients will be provided with a copy of the terms and conditions of the
Scholarship Scheme at the commencement of their scholarship, and will be required to
sign a Scholarship Acceptance Form.

If your application is successful you must provide all of the following documents. Not
providing all documents will adversely affect your application.

Certified copy of evidence of your name change (if applicable)

Certified copy of evidence of your Australian citizenship or permanent residency

Certified copy of your current practising certificate/registration card
Copy of information relating to enrolment details

Scholarship payments will not commence until the signed Scholarship Acceptance Form,
confirmation of placement, and any other requested documentation, is received by
RCNA.

Ongoing Award of Scholarship Places

Ongoing award of scholarship places depend upon the scholarship holder continuing to
meet the eligibility criteria.

Scholarship holders must notify RCNA in writing of any substantial change to their
financial circumstances or other eligibility criteria. This information must be received by
RCNA within fourteen (14) days of the changes taking place. If the scholarship holder
fails to inform RCNA of such changes, they will have ceased to meet the eligibility criteria
and will be required to repay any funds received after the changes took place.

Repayment of Funds

If the scholarship holder ceases to fulfil the terms of the scholarship and does not inform
RCNA, they will be required to repay funds received from the time they ceased to be
eligible.

It is in the scholarship holder’s best interest to notify RCNA if they no longer fulfil the
terms of the scholarship. If a scholarship is withdrawn, no further payments will be
made.

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PART A - Office Use Only NAHSSS:PG No:

Nursing and Allied Health Scholarship and Support Scheme:

Postgraduate Scholarships

SECTION A: APPLICANT DETAILS

Title Given name Second given name Family name

Note:
If your application is successful you will be required to provide a certified copy of
relevant documents if your name/s has changed e.g. Marriage Certificate

Home street address Town/Suburb State & Postcode

Postal address Town/Suburb State & Postcode

Telephone Facsimile Email

- Day
Home
- Evening
Work
- Mobile
Education institution

Date of Birth (DD/MM/YYYY) Sex (please circle)

Male Female

Is English your first language?

□ Yes □ No

Are you an Aboriginal or Torres

Strait Islander? □ Yes □ No

Please note
Make sure the contact details you provide are current. It is important that the postal
address and telephone numbers are correct. If there is a need to speak to you, this will
be during standard business hours (9am to 5pm, Monday to Friday, Australian Eastern
Standard Time)

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PART A - Office Use Only NAHSSS:PG No:

SECTION B: ELIGIBILITY CRITERIA

Question Are you an Australian citizen or permanent resident of Australia?

1

Yes □ Continue with the questions below

Note:

If your application is successful you will be

required to provide a certified copy of your
birth certificate, naturalisation papers, or other
official documents such as a passport

No □ You are not eligible for this scholarship

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PART A - Office Use Only NAHSSS:PG No:

SECTION C: REGISTRATION AND PRACTISING CERTIFICATE INFORMATION

Question 2 Are you currently registered as a registered nurse, enrolled nurse or

midwife in an Australian State or Territory?

Yes □ Note:
If your application is successful you will be
required to provide a certified copy of your
current practicing certificate/registration card
Please attach a certified copy of your current
practicing certificate/ registration card

No □ You are not eligible for this scholarship

What State or Territories are you currently registered in?

What is your current role?

What health care settings and/or specialities do you currently work?

General practice □ Community □ Midwifery □

Acute care □ Aged care □ Mental health □
Nurse practitioner □ Other □ (please state below)

______________________________________________________________

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PART A - Office Use Only NAHSSS:PG No:

SECTION D: COURSE INFORMATION

Name of course:

................................................................................

Name of course provider/institution:

................................................................................

Course provider/institution campus and address:

................................................................................

Proposed start date:

_____/_____/201

Proposed completion date:

_____/_____/201

In which State/Territory is this course offered? Please circle

ACT NSW VIC QLD WA SA TAS NT

Are there any similar courses offered in the State/Territory in which you reside? Please
list:

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PART A - Office Use Only NAHSSS:PG No:

SECTION E

Question 4 How did you hear about the Nursing and Allied Health
Scholarship and Support Scheme: Postgraduate
Scholarships? (please tick)
Colleague/friend/relative
□
Newspaper
□
Poster
□
Radio
□
Email
□
Website
□
Educational institution
□
Professional organisation
□
Employer
□
School
□
Facebook
□
Google
□
Television
□

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Nursing and Allied Health Scholarship and
Support Scheme

Postgraduate Scholarships

PART B

SELECTION QUESTION

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PART B - Office Use Only NAHSSS:PG No:

Section A: SELECTION QUESTION

Is English your first language (please circle) Yes No

Question 1
Responses must Discuss how this scholarship will benefit you in furthering your
be limited to 200 career, how you have shown your commitment to your chosen
words and may be profession and how your life experiences and professional career to
in point form. date demonstrate your commitment to nursing.

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DECLARATION

This declaration is legally binding and indicates that you have, to the best of your
knowledge, provided true and correct information.

This declaration must be completed.

Declaration

I declare that:
• The information that I have supplied in this Application Form is true and correct.
I understand that there are penalties that apply to providing false information.
• I will advise RCNA in writing of any changes in my circumstances, within 14 days
of those changes occurring.

I understand that:
• The information on this form is collected for the purpose of assessing eligibility
and selection for the Nursing and Allied Health Scholarship and Support Scheme:
Postgraduate Scholarships.

I agree to:
• Sign an acceptance agreement with Royal College of Nursing, Australia if
successful in my application for the Nursing and Allied Health Scholarship and
Support Scheme: Postgraduate Scholarships.
• The information contained in this application form being released to the
Department of Health and Ageing and members of a selection panel for the
purpose of assessment and eligibility for the Nursing and Allied Health
Scholarship and Support Scheme: Postgraduate Scholarships.

--------------------------------------- / /2010
Signature of applicant Date

AND (if applicable)

--------------------------------------- / /2010
Signature of person completing the Date
application form on the applicant’s behalf

Please note
This declaration is legally binding. It is evidence that the information you have provided
is, to the best of your knowledge, true and correct. There are penalties for knowingly
giving false or misleading information.

The information in this Application Form may be used for evaluation purposes. If this
occurs, the information will be de-identified so that individual applicants cannot be
identified.

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PROMOTIONAL ACTIVITY AGREEMENT

Agreement to Participate in Promotional Activity

I agree to the Department of Health and Ageing and/or the Minister for Health and
Ageing:

• Using my personal information, including my name, suburb/region, state/territory

and the tertiary institution that I am attending/attended, as the Department or
Minister sees fit, for the purposes of promoting and publicising the Nursing and
Allied Health Scholarship and Support Scheme: Postgraduate Scholarships to
Members of Parliament and the media.

-------------------------------- / /2010
Signature of applicant Date

AND (if applicable)

---------------------------------- / /2010
Signature of person completing the Date
application form on the applicant’s behalf

Please note
The Minister for Health and Ageing and the Department of Health and Ageing may wish
to release information about you for the purpose of promoting the Scholarship Scheme.
This would include only your name, suburb/region and state/territory, along with
information about your course of study and educational institution. Personal information
such as telephone number, email details or address would not be released.

Scholarship holders may be asked to participate in promotional activities. In signing this

declaration, you agree to the release of this information and to participate in promotional
activities.

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