APPLICATION
EMST Instructor Scholarship 2014
Name
A brief summary of my current role in trauma care
Proposed Scholarship activities (including detailed itinerary, site visit and contacts)
How participation in these activities will enhance my trauma care practice
How the EMST program will benefit from my participation in the proposed activities

I plan to teach EMST for a minimum of 5 more years
Statement
“I agree to abide by the decision of the Selection Panel for the EMST and Smith & Nephew Instructor Scholarships and to fulfil the
requirements of the Scholarship, as outlined in the “EMST and Smith & Nephew EMST Instructor Scholarship Guidelines” “
Signed
Date
Please attach a copy of your Curriculum Vitae and return to:
Skills Training Department
Royal Australasian College of Surgeons
250-290 Spring Street
East Melbourne VIC 3002
Tel: 03 9249 1289
Fax: 03 9249 1298
Email: EMST@surgeons.org
Applications must be received by: 5 pm, Friday 20 June 2014