2 October 2006 - Florence Nightingale · Web viewTHE FLORENCE NIGHTINGALE FOUNDATION...
6
THE FLORENCE NIGHTINGALE FOUNDATION APPLICATION FOR A TRAVEL SCHOLARSHIP 2017-2018 PERSONAL DETAILS Surname/Family name First name Title (e.g. Mr/Mrs/Ms/Miss/Dr) NMC Pin Number It is essential that all the above details be correctly given to enable us to check your registration with the NMC Ethnic origin - Please tick White Mixed / Multi ethnic Asian / Asian British Black / African / Caribbean / Black British Other ethnic group Please describe: Prefer not to say Home address (full including postcode) Home telephone number Mobile telephone number Home email address How did you hear about these scholarships? (e.g. word of mouth, CNO Bulletin, publication or direct email, etc.)
Transcript of 2 October 2006 - Florence Nightingale · Web viewTHE FLORENCE NIGHTINGALE FOUNDATION...
THE FLORENCE NIGHTINGALE FOUNDATIONAPPLICATION FOR A
TRAVEL SCHOLARSHIP 2017-2018
PERSONAL DETAILSSurname/Family name
First name
Title (e.g. Mr/Mrs/Ms/Miss/Dr)
NMC Pin Number
It is essential that all the above details be correctly given to enable us to check your registration with the NMC
Ethnic origin - Please tick
WhiteMixed / Multi ethnicAsian / Asian BritishBlack / African / Caribbean / Black BritishOther ethnic groupPlease describe:Prefer not to say
Home address (full including postcode)
Home telephone number
Mobile telephone number
Home email address
How did you hear about these scholarships? (e.g. word of mouth, CNO Bulletin, publication or direct email, etc.)
PROFESSIONAL AND HIGHER EDUCATION (Undergraduate and post-graduate of 1 year’s length or more)
Qualification obtained
Institution (name, city, country)
Datecommenced
Major field of study
Year completed
Summary of relevant health care experience
(Maximum of 200 words)
CURRENT EMPLOYMENT DETAILSJob title and Band/Grade
Organisation name
Work address (full)
Work telephone number
Work email address
Chief Executive or equivalent head of organisation
Director of Nursing or equivalent head of service
Name: Name:
Email address: Email address:
Page 2 of 5
DETAILS OF PROPOSED RESEARCHTitle of Study
Please outline the aims / learning outcomes of the professional study
(150-200 words)
Please outline the anticipated benefits of the study to patients / clients within your area of responsibility and to your current and future practice
(200-300 words)
Country or countries and / or centres to be visited
Draft itinerary*please see template
Estimated cost of study tour
Rationale for places chosen
Contacts made with centre(s) to be visited
Please outline your proposals to disseminate the knowledge and experience acquired
Please provide details of any other funding for which you have applied
*The itinerary template can be found here: http://www.florence-nightingale-foundation.org.uk/content/page/46/
The quality, not quantity, of this information and its presentation will be an important part of the selection process.
Page 3 of 5
REFERENCESReference 1 (Current Line Manager):
Acts as a character reference, attests to the suitability of you undertaking the scholarship and agreement to support you through your scholarship;
Reference 2 (Managerial):
Provides proof of place of work, acknowledge their support and confirm they understand what it entails (study leave etc.)
Name and title Name and title
Work Address (including post code) Work Address (including post code)
Email address Email address
Telephone number Telephone number
Mobile telephone number Mobile telephone number
It is your responsibility to notify your referees and ensure that references are received WITH YOUR APPLICATION. Please ensure that references are submitted WITH YOUR APPLICATION. This is a vital part of the application process. If we do not receive them with your application it will not be considered.
Page 4 of 5
The Foundation cannot pay for secretarial assistance, IT equipment, stationery, replacement staff costs or study leave. This application can only be considered for funding for the year of 2017/18. A scholarship cannot be awarded retrospectively.
Completed applications, together with two references, should be emailed to arrive no later than 21 st July 2017 to:
The Office ManagerThe Florence Nightingale FoundationEmail: [email protected]
Applications will be acknowledged on receipt and you will be notified whether you have been shortlisted for interview or not by 25th August 2017.
Candidates who are shortlisted will be interviewed on one of the following dates:
5th, 6th, 9th and 10th October 2017
Any candidate who is unable to attend for interview on these dates cannot be considered.
Travel costs are not reimbursed to successful candidates but a contribution can be negotiated by candidates who are unsuccessful at interview. Skype technology may be available for interview for those at a long distance.
The Foundation complies with the provisions of the Data Protection Act 1998.
Page 5 of 5
