NES SCHOLARSHIP APPLICATION FORM Please complete all boxes on this form except the shaded grey areas. This form should be submitted with a letter of support from your line manager. The letter should be signed and on headed paper, or sent to cyp.msc@ed.ac.uk from the line manager’s NHS e-mail account (forwarded e-mails will not be accepted). Scholarship applications will only be considered once an application has been made through EUCLID for a programme of study, providing a unique university number (UUN), or if a paper application has been received for a CPD course. All documents must be received by 30th June for semester 1 courses, or 30th November for Semester 2 courses. The completed form and supporting documentation should be sent to Lorna Sheal, MSc CYPMHPP, Medical School, Teviot Place, Edinburgh EH8 9AG or cyp.msc@ed.ac.uk We award on an annual basis, and will endeavour to support ongoing studies. Please only request for courses you plan to study in the forthcoming year. Applicant details Full Name Correspondence Address UUN (e.g. s123456) Job Title Health Board Professional Group/Qualification (e.g. nursing) Study plans Programme of Study (Please select one) CPD course PGCert cyCBT PGCert Psychological Interventions for Children and Young People PGCert Children and Young People’s Mental Health and Psychological Practice PGDip Children and Young People’s Mental Health and Psychological Practice MSc Children and Young People’s Mental Health and Psychological Practice Date commencing studies Date of completion (planned) Scholarship Request Please list the courses you are seeking a NES scholarship for in this academic year Name of course Cost Total Do you have other funding sources? Yes/No If yes, please provide details of funding sources Supporting statement How will the programme of study be useful to your work? How will learning be applied in practice? Please list any other academic or training courses you have completed since qualifying. You do not need to include mandatory training, conferences or one-off CPD events Line Manager Approval? Yes/No University Offer Made? UO/CO/Reject Decision (sum awarded) Notes NES Representative University Representative Signature Signature Date Date