COLLEGE OF NURSES AOTEAROA

Trailblazer Travel Awards 2012

The two Trailblazer Travel awards valued at $1000 are available for a Registered Nurse to attend or present at a New Zealand or International conference.

The award may be held concurrently with another scholarship or bursary, and is non-taxable in New Zealand.

Consideration will only be given to applications submitted on the official application form, word processed and in the requested format. Please submit via -

Post to College of Nurses, PO Box 1258 Palmerston North 4410

or

email to admin@nurse.org.nz (All attachments must be in the one email please.)

Applications are to be addressed to the Administrator, CNA (NZ) and will be considered by a quorum of no less than two members of the Scholarship Committee.

The Scholarship Committee will make a written recommendation to the Board for consideration and final approval. In any year the Scholarship Committee may refrain from making one or more recommendations if no suitable applicant is found.

Each award will be made on merit, taking into consideration the nature of the planned study/research, as well as the applicant's academic merit and participation in the profession and the College.

The Trailblazer Registered Nurse Travel Award cover conference registration, travel and accommodation to a maximum of $1000. Applicants are expected to complete travel by the 30 June 2013 and provide a report on the outcomes of conference attendance. Retrospective costs will not be considered. Applications close 30th September 2012.

Successful recipients will need to provide a report on the conference attendance to the Board of the College of Nurses within 6 weeks of returning from the conference.

It is an expectation that recipients remain a member of the College for the duration of the scholarship term.

An inability to complete planned travel or maintain College membership because of extenuating circumstances will require discussion and may involve partial or full repayment of the award.

COLLEGE OF NURSES (NZ) AOTEAROA Inc

APPLICATION FOR Trailblazer Travel AWARD 2012

PART 1: PERSONAL INFORMATION - (Please word process your application)

Last/Family name
First name(s)
Postal address Suburb and Postcode
Phone no – hm wk Cell
Email
Identification as Maori (please indicate)	Yes No
Hapu / iwi
Student nurse	Yes No
Award applied for (/ select one)	A) Trailblazer Registered Nurse Travel Award $750

I certify that the details contained in this application are correct.

Signed:	_____________________________________

Date:	_____________________________________

PART 2: BACKGROUND INFORMATION

Please supply a brief 1-2 page curriculum vitae and appropriate evidence to support your application. For example, evidence of enrolment in undergraduate / post-graduate study or academic transcript.

College membership and activity:
Current financial membership of CNA (NZ)?	Yes No
How many years have you been a member?
Outline involvement in college activities. Eg. Network, conference, mentoring, student, etc

Nursing Registration and related professional development: (If nursing student, please indicate and proceed to next question).
Registration type
Year of registration(s):
Current annual practicing certificate	Yes/ No Please attach photocopy
Briefly outline relevant professional development and/or continuing education undertaken over last 5 yrs. Eg. Training, education, workshops, conferences, specialty practice programmes, etc

Academic Qualifications: list completed and/or qualifications in progress. If you are a nursing student, please indicate where you are studying and when you expect to complete.
Qualification	Institution	Year awarded or expected to complete.

Contribution to Nursing
Outline contribution to nursing at a local and/or regional and/or national level:
Outline any community work that relates to and/or supports your application:

Contribution to Maori Health: (for colleagues who identify as Maori only)
Please describe your contribution to and/or involvement in the area of Maori health needs.

PART 3: PROGRAMME FOR WHICH THE SCHOLARSHIP APPLICATION IS MADE.

In no more than one page, please outline your planned programme of travel and how you intend to use this award to develop/extend your own practice as a nurse. Include evidence to support your application eg. Proof of enrolment; ethical approval; letter of support, conference registration, travel cost, itinerary etc

PART 4: APPLICATION CHECKLIST

Evidence and information required
Personal details completed
Application signed
CV attached
Photocopy of APC (Registered Nurses only)
Evidence of enrolment in undergraduate or post-graduate programme if applicable
Photocopy of academic transcripts or degree – please no originals
Evidence to support study / research / practice development/ travel e.g. Ethics approval, letters of support, business case, project plan, conference registration, travel cost, itinerary.

Thank you for your application.