FACULTY OF HEALTH APPLICATION FORM 2015 Ron Macnamara Rural Nursing Scholarship For students in: NS85 Master of Nursing NS86 Master of Nursing Science (Nurse Practitioner) Applicant Details: Family Name: ______________________ Given Name/s: __________________________________ Student Number: __________________________ Email: ___________________________________ Postal Address: ___________________________________________________________________ ______________________________________________ P/Code: ___________________________ Telephone number: (H) ___________________ (Mobile) _________________________ (W)___________________ Preferred Contact Number: (please circle): (H) (W) (Mob) Your course code or title: ____________________________________________________________ Please provide the following information with this form:  A certified copy of your academic record if your studies were not at QUT  A current Curriculum Vitae showing employment since completion of your nursing qualification  A statement (up to one A4 page) indicating how you are committed to working in rural and remote areas of Australia in the future  A statement (up to one A4 page) providing information on your financial situation and how the scholarship would benefit you APPLICATIONS CLOSE AT 5:00PM WEDNESDAY 3 DECEMBER 2014 Declaration: I declare that, to the best of my knowledge and belief, all the information I have provided above is true and correct. Signature: ___________________________________________ Date: __________________ Applications may be: Emailed to: [email protected] Please place “Confidential – Ron Macnamara Rural Scholarship” in the subject panel About the scholarship Ms Laurie Cowled honours her late husband, Ron Macnamara, who passed away in February 2005 through the offering of The Ron Macnamara Rural Nursing Scholarship. This Scholarship aims to foster the further education of advanced practice nurses and nurse practitioners, with a view to making a difference to the future of rural Australia. Ms Cowled and her husband had always planned to leave their estates to charity. After her husband's passing in 2005, Ms Cowled made the decision to honour their pledge and now supports many aspiring students across Australia. To be eligible to apply you must be: • an Australian citizen or permanent resident • enrolled or intending to be enrolled in NS85 Master of Nursing or NS86 Master of Nursing Science (Nurse Practitioner) • committed to working in rural and remote areas of Australia in the future Applications will be assessed on • academic merit • financial need Preference will be given to candidates from rural or regional Australia who would not be able to study without financial assistance. Previous awardees are eligible to apply. The recipient will receive $10,000 paid in two instalments over one year. QUT staff will help you to make contact with rural networks to take part in activities that maintain or develop ties to rural Australia and to develop knowledge and understanding of working as a nurse in rural areas. You will also have the opportunity to be linked to a rural nurse mentor, where appropriate. A panel will shortlist the applications and interview potential recipients following the closing date. The selection process will be finalised in December 2014 and all applicants will be notified of the outcome of their applications.