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Nurses Board of Victoria Legacy Limited
Grants and Fellowships
MINOR GRANTS APPLICATION AND GUIDELINE FORM 2016
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June Allen Practice Enhancement Grant
Enrolled Nurse Practice Enhancement Grants
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William Cooper Fellowship
Application close at 4pm Friday 18th September 2015
OBJECTIVE
To enhance nursing and midwifery practice and knowledge in Victoria
ELIGIBILITY
To be eligible for any of the Nurses Board of Victoria Legacy Limited (NBVLL) grants and fellowships,
applicants must be currently registered with the Nursing and Midwifery Board of Australia. Funding
under NBVLL is open to Nurses and Midwives whose principal place of practice is Victoria. Eligibility
criteria for each of the grants individually is outlined below.
FUNDING
Funding is normally for a period of 12 months. Extensions must be applied for and may be approved
by the NBVLL Board of Directors.
PREVIOUS APPLICANTS
Those who have previously received funding through NBVLL must wait two calendar years before they
are eligible to apply again. Applicants who have previously been unsuccessful may re-apply in the
following round providing they still meet the eligibility criteria.
SUBMISSION OF APPLICATIONS
It is preferred that applications be typed, however hand written applications will be accepted.
Completed forms must be printed, signed and forwarded to:
NBVLL Secretariat
PO Box 327
WENDOUREE VIC 3355
Applications postmarked on or before the closing date will be accepted. It is recommended that
applicants keep a copy of their application until they are notified that it has been received by the
NBVLL Officer. Notification of receipt will be sent via email.
SELECTION PROCESS
All eligible applications will be reviewed based on the information provided in the application form.
Grants worth less than $20,000 will be reviewed by at least two reviewers and grants worth $20,000
and over will be reviewed by three reviewers. If further information is required in order to assess your
application, you will be contacted by the NBVLL Officer.
NOTIFICATION PROCESS
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Applicants will be notified of the outcome of their submission by mail by the end of November 2013.
The decision of the NBVLL Board is final and no correspondence will be entered into. Applicants may
request to be provided with feedback from the review process.
CONDITIONS
Please see terms and conditions at the end of this application
Please indicate the type of grant you are applying for: If you require any assistance in
completing this application form call 1800 559 136.
JUNE ALLEN PRACTICE ENHANCEMENT GRANT
Value: Up to $3,000
The purpose of this grant is to enable registered nurses and/or registered midwives who are directly
or indirectly involved in clinical practice in any clinical setting to undertake activities that will enhance
and develop innovative approaches to nursing and midwifery practice. Eligible activities may include
small clinically based projects, mentoring in clinical practice or professional education including small
modules or seminars. Funding is not available for education leading to an award e.g. postgraduate
qualification.
ENROLLED NURSE PRACTICE ENHANCEMENT GRANTS
Value: Up to $3,000
The purpose of this grant is to enable enrolled nurses who are directly or indirectly involved in clinical
practice in any clinical setting, to undertake activities that will enhance and develop innovative
approaches to nursing practice. Enhancements may include changes to practice and policy
development. Eligible activities may include small clinically based projects, mentoring in clinical
practice or professional education including small modules or seminars. Funding is not available for
education leading to an award e.g. postgraduate qualification.
MARJORY TAYLOR FELLOWSHIP
Value: Up to $3,000
The purpose of this fellowship is to support registered nurses and/or registered midwives whose
primary place of practice is in the Barwon region of Victoria in their efforts to undertake nursing and
midwifery education (courses or professional development), to advance their knowledge and skills in
their particular field, or undertake research relating to nursing and midwifery.
WILLIAM COOPER FELLOWSHIP
Value: Up to $3,000
The purpose of this fellowship is to enable registered nurses who are directly or indirectly involved
with caring for patients with cancer in Victoria to undertake activities that will enhance nursing
practice. The Fellowships will be awarded to assist the development of innovative approaches to
enhancing nursing practice. Eligible activities may include projects for changing clinical practice,
mentoring in clinical practice or professional education including small modules or seminars. Funding
is not available for education leading to an award e.g. postgraduate qualification.
A
APPLICANT DETAILS
Title:
Given Name:
Surname:
Postal Address:
Suburb:
State:
Postcode:
Residential Address:
Suburb:
State:
BH Tel:
Postcode:
Mobile:
Email address:
NMBA Registration ID Number:
Employing organisation:
Position held:
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Do not exceed the end of page 3 for questions B1, 2, 3 and 4.
B
GRANT PROPOSAL
Please keep proposal within space provided as additional pages will not be considered.
1.
Activity Title (maximum 25 words)
2.
Briefly describe the activity for which you are seeking funding.
Do not exceed 100 words for this section. If the activity is a research-based project including
presentation at a conference, please detail the method in section C.
3.
What are the aims and/or objectives of this activity?
4.
Describe the timeline for the activity including the start, finish and other
milestone dates. (for conference attendance detail event dates)
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Do not exceed the end of page 4 for questions B5 and 6.
5.
How will this activity contribute to enhancing nursing/midwifery practice?
6.
How will you share the outcomes of this activity?
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Do not exceed the end of page 5 for questions C1 and 2.
C
RESEARCH BASED PROJECT OUTLINE
Only complete this page if your activity is a research-based project including presentation at a
conference.
1.
Detail the method proposed including the reasons, benefits and relevance to your role
in relation to your activity
2.
Details of ethics clearance (if required).
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D
FUNDING
Has any other funding been sought for this activity?
Yes
No
If yes, please detail the funding source (name and address of each agency) and the amount
requested.
Have you or members of your team previously been awarded a Nurses Board of Victoria Legacy
Limited Grant or Fellowship?
Yes
No
If yes please state year, name of Grant or Fellowship and activity title. Please note applicants who
have received a grant in the previous 2 calendar years are not eligible to apply.
E
BUDGET
Prepare the budget for your activity including the cost of each item, the total amount and a brief
justification.
Item
Total Budget
Amount
Justification/rationale
$
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F
REFEREES
Please provide the names and addresses of two professional referees who are familiar with your role
in the area of your selected activity.
Referee 1
Surname:
Given name:
Title:
Position held:
Facility/Organisation:
Address:
Suburb:
State:
BH Tel:
Mobile:
Postcode:
Email address:
Referee 2
Surname:
Given name:
Title:
Position held:
Facility/Organisation:
Address:
Suburb:
State:
BH Tel:
Mobile:
Postcode:
Email address:
G
CERTIFICATION OF HEAD OF ORGANISATION
If the proposed activity requires the use of your work facilities for the activity or leave to undertake
the activity, please ensure this section is completed.
I certify that the proposed activity is appropriate to the general facilities of my organisation
and that I am prepared to have the activity carried out in my organisation or support leave from work
for this activity to be undertaken.
If payment for the proposed activity is to be made to your work facility, please ensure this section is
completed.
I certify that this request satisfies all the requirements of this organisation, and that this
organisation has established financial administrative processes for assuring sound ethical practice in
relation to disbursement of the grant funds.
Surname:
Given name:
Title:
Name of Organisation:
Position held:
BH Tel:
Mobile:
Email address:
Signature:
Date:
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H
CURRICULUM VITAE
Please attach one page curriculum vitae that includes the following information:
Details of qualifications.
A brief description of the duties and responsibilities associated with your current
employment.
Publications and/or contribution to the profession.
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I
APPLICANT AGREEMENT
In signing this section, you certify that all details provided on this application form are true and
correct at the time of applying.
Signature:
J
Date:
HOW DID YOU HEAR ABOUT NBVLL GRANTS AND FELLOWSHIPS?
Website
NBVLL website
Australian College of Nursing
Department of Health
Facebook
Google
Publication/Newspaper
ANF Journal
Nursing Review
Geelong Advertiser
Other
Direct Email
Manager
Colleague/Friend
Workplace
TERMS and CONDITIONS
Original receipts will only be accepted. NBVLL grants and fellowships are only for the named recipient.
Alcoholic beverages, or incidentals otherwise claimed via salary sacrifice will not be reimbursed. The
NBVLL Board of Directors reserves the seek clarification for costs incurred and may request additional
information from the recipient. Successful recipients are required to be a reviewer for NBVLL grants
and fellowship applications in the calendar year following completion of their grant or fellowship.
CHECKLIST FOR COMPLETION OF APPLICATION
Before submitting your application, please ensure that you have:
Completed all relevant sections of the application form
Included evidence you meet the eligibility criteria. This may include a current practicing certificate
or proof of employment.
A one page copy of your Curriculum Vitae (CV)
Indicated support from host (observational visits only)
Read and understood terms and conditions of the NBVLL grants and fellowships
Optional
Conference brochure/program if available
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