2018 STUDY TOUR USA & CANADA

Transcription

1 2018 STUDY TOUR USA & CANADA 2018 SCHOLARSHIP APPLICATION FORM This form is the foundation of your application for a Victorian Healthcare Association Study Tour 2018 scholarship. Title: Given names: Surname: Address: Suburb: Postcode: Contact telephone numbers: Work: Home: Mobile: Citizenship: Please list other awards/grants you have applied for and/or been awarded: EMPLOYMENT Provide details of your present and past employment Present position: Work area: Organisation name: Is your organisation: rural regional metropolitan community health Job title: When did you commence work in this position:

2 Give details of your two previous positions: Position held: Organisation: Period worked: REASONS FOR APPLICATION 1.1 What has motivated you to apply for the VHA Study Tour 2018 Scholarship? 1.2 What do you hope to achieve should you be successful in being awarded a VHA scholarship? 1.3 Which particular area of interest is being covered on the study tour? 1.4 Outline your current experience and knowledge in relation to the study tour areas. 1.5 How well does your area of interest align with the strategic directions of your healthcare organisation?

3 1.6 Describe the need for your proposed learnings and how these will contribute to current practice in your health service and the Victorian healthcare system? 1.7 What type of issues do you wish to explore during the site visits of the study tour? WHICH SCHOLARSHIP ARE YOU APPLYING FOR? The VHA is offering three scholarships to participate in the 2018 Study Tour to USA and Canada. The scholarships are open to CEO or senior executives of VHA member organisations. Please indicate which scholarship you are applying?: Community Health Metropolitan Health Service Rural or Regional Health Service EXPECTATIONS OF SCHOLARSHIP RECIPIENTS: All scholarship recipients are expected to share the learnings of the tour beyond their own health services. Recipients are required to: 1. Prepare an article on the findings in your area of interest to the VHA within six weeks of completing the tour. The paper should be approximately 1000 words and can include photos and diagrams. 2. Present at VHA event promoting the study tour and the findings. 3. Undertake an interview with the VHA communications team for the purpose of promoting the 2019 tour. PROJECT INFORMATION Indicate the area of interest you wish to pursue (you may tick more than one): Please indicate which scholarship you are applying?: Indigenous health Patient/consumer engagement Vulnerable persons Quality and safety in healthcare

4 APPLICATION Successful recipients will receive one attendee place on the Victorian Healthcare Association s 2018 Study Tour to USA and Canada. Scholarship includes: One return international economy airplane ticket One economy ticket for all internal flights Accommodation, including breakfast at the hotel Airport transfers Scholarship does not include: Meals, unless previously stated Social activities Sightseeing activities Extra days that may be added to the study tour dates by the recipient Upgrades of flights or accommodation Terms and conditions: Successful recipients acknowledge the VHA expectations and agree that these must be completed within 12 months of the completion of the tour. The scholarship is not transferrable and cannot be redeemed for cash. The scholarship is only available for the 2018 study tour. A steering committee appointed by the VHA will assess and evaluate the submissions. The committees decision is final and no further correspondence will be entered into. Applications close COB Friday 26 February I have read and understood the terms and conditions as detailed above. Please tick Signature: Date: Ensure that the Employer Support Form is completed and attached with your application. For more information contact: Kerri Langes VHA Director of Membership and Events Kerri.langes@vha.org.au or

5 EMPLOYER SUPPORT FORM The Chief Executive or the Board Chair must sign this form. This form acknowledges that the applicant s employer will fully support the applicant if they are awarded a scholarship to the VHA 2018 Study tour of USA & Canada. Organisations name: CEO or Board Chairs name: Contact phone number: Contact Applicant s name: The applicant is applying for a scholarship to participate in the Victorian Healthcare Associations 2018 Study Tour of USA & Canada. If successful the applicant will be travelling overseas from Friday 21 September to Saturday 6 October Scholarship includes: One return international economy airplane ticket One economy ticket for all internal flights Accommodation, including breakfast at the hotel Airport transfers EXPECTATIONS OF SCHOLARSHIP RECIPIENTS: All scholarship recipients are expected to share the learnings of the tour beyond their own health services. Recipients are required to: 1. Prepare an article on the findings in your area of interest to the VHA within six weeks of completing the tour. The paper should be about 1000 words and can include photos and diagrams. 2. Present at an VHA event promoting the study tour and the findings. 3. Undertake an interview with the VHA communications team for the purpose of promoting the 2019 tour. It is important that the employer support the applicant if they are successful by approving leave to attend the study tour and to support the applicant in complying with expectations of the recipient at the completion of the tour. I have read and understand these conditions and pledge my support to the applicant in these matters. Signature: Date: