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Nurses Board of Victoria Legacy Limited
Grants and Fellowships
MARJORY TAYLOR APPLICATION AND GUIDELINE FORM 2016
Application close at 4pm Friday 18th September 2015
The fellowship is in honour of Matron Marjory Taylor (1920 - 2006).
Marjory was an outstanding nurse and mentor, and the Director of
Nursing at The Geelong Hospital from 1956 – 1981. On Marjory's
retirement, a group of dedicated nurses established the fellowship
to offer support for midwives and nurses undertaking education in
the Barwon Region. In 2002 the then Nurses Board of Victoria took
over the governance of the Marjory Taylor Fellowship. The Nurses
Board of Victoria Legacy Limited continues to offer this fellowship
today and respectfully acknowledges the ongoing commitment of
the nurses in the Barwon Region, who continue to offer support for
Marjory Taylor Fellowship
OBJECTIVE
The purpose of this fellowship is to support registered nurses and/or midwives working and living 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
ELIGIBILITY
Applicants must be currently
registered with the Nursing and
Midwifery Board of Australia and
living and working in the Barwon
Region to be eligible to apply for
the NBVLL Marjory
Taylor Fellowship.
The Barwon Region is highlighted
in yellow. Applications from
outside this area will not be
considered.
Nurses Board of Victoria Legacy Limited Grants and Fellowship
Application Form - 2016 Round
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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 and
must meet the selection criteria. Grants will be reviewed by at least two reviewers from the Barwon
region. If further information is required in order to assess your application, you will be contacted by
the NBVLL Officer.
NOTIFICATION PROCESS
Applicants will be notified of the outcome of their submission by mail by the end of December 2014.
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
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Application Form - 2016 Round
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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.
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:
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.
3.
What are the aims and/or objectives of this activity?
Nurses Board of Victoria Legacy Limited Grants and Fellowship
Application Form - 2016 Round
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4.
Describe the timeline for the activity including the start, finish and other
milestone dates. (for conference attendance detail event dates)
5.
How will this activity contribute to enhancing nursing/midwifery practice in the
Barwon Region?
6.
How will you share the outcomes of this activity to others in the Barwon Region?
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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Application Form - 2016 Round
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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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Application Form - 2016 Round
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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.



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 right to 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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Application Form - 2016 Round
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