Puggy Hunter Memorial Scholarship Scheme

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1 Puggy Hunter Memorial Scholarship Scheme Indigenous health scholarships An Australian Government initiative to assist Indigenous students gain professional health qualifications and increase the number of Aboriginal and Torres Strait Islander people in the health workforce. Application form Forward completed application form to: Puggy Hunter Memorial Scholarship Scheme Australian College of Nursing PO Box 219 DEAKIN WEST ACT 2600 Closing date for applications: Monday 16 September 2013 ACN, Australia s professional organisation for all nurses, is proud to work with the Department of Health and Ageing as the fund administrator for this program

2 If you anticipate or experience any difficulty in lodging your application form by the closing date of Monday 16 September 2013, please contact Australian College of Nursing (ACN). The sooner you do this, the more options that may be available. Freecall: You may apply for a scholarship either online at or by completing this hard copy version. Hard copy applications may be lodged by scanning and ing to or by post to the above address. Faxes will not be accepted. BACKGROUND The aim of the Puggy Hunter Memorial Scholarship Scheme (PHMSS) is to encourage and assist Aboriginal and Torres Strait Islander undergraduate students in health-related disciplines to complete their studies and join the health workforce. The scholarship provides financial assistance to Aboriginal and Torres Strait Islander people who are intending to enrol or are enrolled in an entry level course in an eligible health related profession at an Australian educational institution (Certificate IV and above). ELIGIBILITY Funding under this scheme is available for applicants who meet the following criteria: Aboriginal and/or Torres Strait Islander intending to enrol or are already enrolled in an entry level health course intending to study in Please note the scholarships are very competitive and there may be more applications than there are available scholarships. Therefore, not all eligible applicants will receive a scholarship. ELIGIBLE STUDY AREAS Scholarship places are awarded to students undertaking an entry level course in one of the following health professions: Aboriginal and Torres Strait Islander health work Allied health (all specialities except pharmacy) Dentistry/oral health (excluding dental assistants) Medicine Midwifery Nursing. These include graduate entry level courses. Examples of allied health The list below contains examples of allied health professions. Please note that this is not a complete list; there may be other eligible professions under PHMSS. Alcohol and other drugs work Audiology Chinese medicine Chiropractic Diet/nutrition Environmental science/health Health promotion Medical imaging technologists Medical physicists Medical radiation science (including diagnostic and therapeutic radiography, and nuclear medicine) Mental health (including but not limited to psychology and social work) FM-F.3.4-SC0014-PHMSS Application V1:May2013 2

3 Occupational therapy Optometry Orthopaedics Osteopathy Paramedics Physiotherapy Podiatry Radiology Speech therapy. If you are not sure if your course meets the criteria, please contact ACN on SELECTION QUESTIONS Scholarships are available through a competitive process and are awarded on the recommendation and ranking of a selection committee, based on how you address the following selection questions: Discuss your commitment to becoming a health professional. Discuss what you hope to accomplish as a health professional in the next 5-10 years. Demonstrate how this scholarship will assist you in achieving your goals. VALUE OF SCHOLARSHIP Full time scholarship awardees will receive up to $15,000 per year. Part time scholarship awardees will receive up to $7,500 per year. The scholarship will be paid fortnightly for the normal duration of your course. Scholarships are not bonded and are not awarded on academic success. It is expected that recipients will make a significant contribution to Aboriginal and Torres Strait Islander health. If you fail to complete your studies within the normal duration of your course you will not be entitled to additional funds. The scholarship does not cover an honours year, with the exception of an applicant undertaking a degree in psychology or if honours is studied within the final year of the program. Please note that it is your responsibility to seek advice from Centrelink on how the scholarship payment will affect your AbStudy or any other Government payment. APPLICATION PROCESS Scholarships will be awarded on the basis of your responses to the questions in this application form. Please note the scholarships are very competitive and there may be more applications than there are available scholarships. Therefore, not all eligible applicants will receive a scholarship. Applications must be submitted to ACN and postmarked on or before the advertised closing date. Unsuccessful applicants may reapply the following year should they continue to meet the eligibility criteria. ACN 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. FM-F.3.4-SC0014-PHMSS Application V1:May2013 3

4 LATE APPLICATIONS Late or illegible applications will not be accepted. If you anticipate difficulties in submitting the application form by the closing date of Monday 16 September 2013, please contact ACN. IMPORTANT INFORMATION Only the information you provide on this application form will be considered. You must answer all questions in the application form as incomplete applications will not be considered for selection. This application form is to apply for the scholarship scheme only. This is not an application for admission to a TAFE or university course. ACN recommends that you do not wait for successful/unsuccessful notification of your scholarship application before contacting the appropriate organisation for a Confirmation of Aboriginality document. You are not required to submit Confirmation of Aboriginality with this application. DOCUMENTS TO BE PROVIDED IF SUCCESSFUL If your application is successful you must provide: certified copy of your Confirmation of Aboriginality document certified copy of evidence of your name change (if applicable) certified copy of your proof of identity confirmation of enrolment in an eligible health related course that results in a nationally recognised and accredited undergraduate/entry level qualification documentation regarding any other scholarships you are receiving. Failure to provide the required documents will results in the withdrawal of the offer of a scholarship place. FM-F.3.4-SC0014-PHMSS Application V1:May2013 4

5 APPLICANT DETAILS Title Given name Middle name Family name Home street address Town/suburb State Postcode Postal address (if different to above) Town/suburb State Postcode Home: Work: Other: Phone Home: Work: Mobile: Age (in years) Gender: Female Male Are you of Aboriginal or Torres Strait Islander descent? Yes No If you have answered no to the above question you are not eligible for this scholarship. Is English your first language? Yes No Please note It is the responsibility of all applicants to ensure that their contact details are correct, and that it is possible for ACN to contact them if required. If you change your postal address or preferred address please ACN at ACN uses as its main form of communication therefore all applicants are required to supply an address that is checked on a regular basis. If there is a need to speak with you, this will be during standard business hours (9am to 5pm, Monday to Friday, Australian Eastern Time). The contact details provided on this application will be used for notification. Notification of the outcome of your application is expected mid November ACN will make all reasonable attempts to contact you. You do not have to provide Confirmation of Aboriginality with this application. If your application is successful, you will be required to provide a certified copy of this document by January If you do not currently hold a Confirmation of Aboriginality document, ACN recommends that you contact the appropriate Indigenous organisation now as it can take some time to go through the processes. A template Confirmation of Aboriginality form can be found at the end of this application if required. FM-F.3.4-SC0014-PHMSS Application V1:May2013 5

6 ENROLMENT INFORMATION Are you currently enrolled or intending to enrol at an Australian educational institution in semester one 2014? Yes Continue with the questions below No You are not eligible for this scholarship What is the area of health you will be studying in 2014? (please tick) Aboriginal and Torres Strait Islander health work Allied health (excluding pharmacy) Dentistry/oral health (excluding dental assistants) Direct entry midwifery Enrolled nursing Health promotion/prevention Medicine Mental health Registered nursing Name of course Educational institution Campus When did/do you commence study? Proposed completion date Semester 20 Semester 20 Will you be studying full time or part time? Full time Part time This is not an application for the stated course. You must apply separately for entrance into your intended course. It is advised that you do not wait for successful/unsuccessful notification of your scholarship application before applying for your nominated course. If your application is successful and you are offered a scholarship, you will be required to provide documentary evidence of your enrolment in an eligible health related course. FM-F.3.4-SC0014-PHMSS Application V1:May2013 6

7 OTHER SCHOLARSHIPS AND INFORMATION Do you expect to receive any other scholarships in 2014? No Yes Please continue to next question Please complete details below Name of other scholarship Funded by Amount per year Other scholarships and bursaries Please provide the name and value of any other scholarships or bursaries that you may receive in This will not affect your application for PHMSS but it will affect the value of the scholarship awarded. Do not include any cadetship details. You are permitted to hold other scholarships; however PHMSS will only top-up any existing scholarship or bursary funds to a maximum cumulative total of up to $15,000 per year for full time study and up to $7,500 per year for part time study. For example, if you currently receive another scholarship valued at $9000 per year, PHMSS will award a maximum of $6,000 per year. Applicants who will be in receipt of an ACN administered Australian Government funded scholarship in 2014 are ineligible. What is the highest level qualification you hold or, if you are currently studying, you will complete by the end of this year? Year 9 Year 10 Year 11 Year 12 Certificate I Certificate II Certificate III Certificate IV Diploma (in any discipline) Bachelor (in any discipline) Postgraduate qualifications Other (in any discipline) Please note: This information will not affect the assessment of your application. How did you hear about the Puggy Hunter Memorial Scholarship Scheme? (please tick a maximum of three options) Conference/expo Course provider Employer Friend/relative Newspaper Poster Professional network/organisation Radio School Television Website Workplace colleague FM-F.3.4-SC0014-PHMSS Application V1:May2013 7

8 SELECTION QUESTIONS Your application will be assessed only on the responses provided to these questions. Question 1 Discuss your commitment to becoming a health professional. Your response must be limited to 200 words and may be in point form. Type or write clearly in blue or black ink. Do not use identifying features such as your name or workplace. Question 2 Discuss what you hope to accomplish as a health professional in the next 5-10 years. Your response must be limited to 200 words and may be in point form. Type or write clearly in blue or black ink. Do not use identifying features such as your name or workplace. FM-F.3.4-SC0014-PHMSS Application V1:May2013 8

9 Question 3 Demonstrate how this scholarship will assist you in achieving your goals. Your response must be limited to 200 words and may be in point form. Type or write clearly in blue or black ink. Do not use identifying features such as your name or workplace. DECLARATION The Declaration is a legally binding document and indicates that you have, to the best of your knowledge, provided true and correct information. There are penalties for knowingly giving false or misleading information. This declaration must be completed. I declare that: The information that I have supplied in the application form is true and correct in every particular. I will advise ACN, in writing, within 14 days of any change in my circumstances. I understand that: The information on this application is collected for the purpose of assessing eligibility and selection for this scholarship. The information on this form may be used for the purposes of obtaining aggregated information about the scholarship program and that any information gathered for this purpose will not identify me in any way. I will be required to accept the Terms and Conditions of the Puggy Hunter Memorial Scholarship Scheme if my application is successful. PRIVACY STATEMENT The National Privacy Principles contained in the Privacy Act 1998 (CTH) and the Privacy Amendment Act 2004, except when qualified by any relevant Codes of Practice, will underpin all matters related to personal information collected by Australian College of Nursing. Signature of applicant Date FM-F.3.4-SC0014-PHMSS Application V1:May2013 9

10 CONFIRMATION OF ABORIGINALITY REQUIREMENTS Successful applicants must provide satisfactory evidence of their Aboriginal or Torres Strait Islander descent as eligibility is limited to persons: of Aboriginal and/or Torres Strait Islander descent who identify as an Aboriginal and/or Torres Strait Islander person who are accepted as being of Aboriginal or Torres Strait Islander descent in the community where they currently or have previously lived. To confirm your status as an Aboriginal or Torres Strait Islander person, you must obtain confirmation in written form (Confirmation of Aboriginality) from an Indigenous Australian organisation within the community in which you live or have previously lived. Community organisations able to provide acceptable confirmation will usually be: (a) an Aboriginal or Torres Strait Islander association incorporated under Part IV of the Aboriginal Councils and Associations Act 1976 or (b) an incorporated community organisation where the majority of the governing body are Aboriginal or Torres Strait Islander persons. Confirmation from a community organisation related to an academic institution will not be accepted. The Confirmation of Aboriginality must be signed by two office bearers, or one office bearer with the common seal affixed. You do not have to provide Confirmation of Aboriginality with your scholarship application. If your application is successful, you will be required to provide a certified copy of this document by mid January If you do not currently hold a Confirmation of Aboriginality document, ACN recommends that you contact the appropriate Indigenous organisation now as it can take some time to go through the processes. The attached Confirmation of Aboriginal and/or Torres Strait Islander Descent form has been developed for use by applicants if you do not currently have Confirmation of Aboriginality that fulfils the Puggy Hunter Memorial Scholarship Scheme requirements. 1

11 CONFIRMATION OF ABORIGINAL AND/OR TORRES STRAIT ISLANDER DESCENT FORM This Confirmation of Aboriginal and/or Torres Strait Islander Descent Form must be completed by the applicant and a recognised incorporated Aboriginal and/or Torres Strait Islander organisation as part of the eligibility criteria of the Puggy Hunter Memorial Scholarship Scheme (PHMSS). The Australian College of Nursing (ACN) recognises that there may be some circumstances where it is difficult for people to obtain confirmation of Aboriginal and/or Torres Strait Islander descent. If this applies, for assistance or advice in completing this form, please contact the scholarships team via at or on freecall SECTION 1 to be completed by the applicant I, also known as (full name) of Make the following declaration (tick all statements that apply): (maiden, community or traditional name) (address) I am of Aboriginal and/or Torres Strait Islander descent. I identify as a person of such descent. I am accepted as such by the community in which I currently live, or formerly lived for years. The community is my traditional area or the area where my ancestors lived for the last years. Applicants signature Date SECTION 2 to be completed by a recognised Aboriginal and/or Torres Strait Islander organisation It is hereby confirmed that the above named applicant has provided sufficient evidence to indicate that he/she is recognised as being of Aboriginal and/or Torres Strait Islander descent. Name of organisation: Resolution number: Date of meeting: Signature: (authorised signatory) Print name: Affix common seal here Signature: (authorised signatory) Print name: *BOTH SECTIONS 1 & 2 MUST BE COMPLETED* GUIDELINES FOR RECOGNISING ORGANISATIONS Community organisations will be responsible to ensure that only people who are of Aboriginal or Torres Strait Islander descent receive benefits to which they are entitled. Community organisations should therefore consider carefully whether to certify the Aboriginal or Torres Strait Islander descent of an applicant who is seeking a scholarship. Community organisations able to provide acceptable confirmation will usually be: (c) (d) an Aboriginal or Torres Strait Islander association incorporated under Part IV of the Aboriginal Councils and Associations Act 1976 or an incorporated community organisation where the majority of the governing body are Aboriginal or Torres Strait Islander persons. Indigenous organisations may include Aboriginal medical services or local land councils. Confirmation from a community organisation related to an academic institution will not be accepted. 2

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