ABORIGINAL, TORRES STRAIT ISLANDER AND MĀORI COMMUNITY MEMBERS BURSARY APPLICATION FORM LIME CONNECTION VI KNOWLEDGE SYSTEMS, SOCIAL JUSTICE AND RACISM IN HEALTH PROFESSIONAL EDUCATION 11 – 13 August 2015 Townsville, Australia KEY DATES Bursary Applications will close on: 12 April 2015 Notification of Acceptance: By 28 April 2015 Deadline for Online Registration: 22 May 2015 LIME NETWORK PROGRAM The Leaders in Indigenous Medical Education (LIME) Network is a program of Medical Deans Australia and New Zealand, supported by financial assistance from the Australian Government Department of Health*. LIME is a dynamic network dedicated to ensuring the quality and effectiveness of teaching and learning of Indigenous health in medical education, as well as best practice in the recruitment and graduation of Indigenous medical students. We seek to do this through establishing a continuing bi-national presence that encourages and supports collaboration within and between medical schools in Australia and Aotearoa/New Zealand and by building linkages with the community and other health science sectors. The LIME Network recognises and supports the primacy of Indigenous leadership and knowledge. *The LIME Network is hosted by the Faculty of Medicine, Dentistry and Health Sciences at the University of Melbourne. LIME CONNECTION The sixth biennial LIMECONNECTION will be held in Townsville, Australia from 11 – 13 August 2015. LIMECONNECTION VI: Knowledge Systems, Social Justice and Racism in Health Professional Education will build on evidence based presentations from previous LIME Connection conferences and capture new initiatives, share successful methods and workshop visions for the future. The theme encourages strengths based presentations relating to Indigenous health teaching and learning, curriculum development and research in health professional education, as well as models for community engagement and the recruitment and graduation of Indigenous students. LIMECONNECTION provides an opportunity for: Collaboration, information sharing and networking amongst peers; Professional development and capacity-building; Linking with community, colleges and those from all health disciplines; Discussion and critique of current practices; and Exploration of emerging tools and techniques to drive improvement in outcomes for Indigenous health. The conference also hosts the LIMElight Awards that acknowledge and celebrate the many current successes in the field. Keynote speakers will include experts in Indigenous health and medical education from Australia, Aotearoa/New Zealand, Hawaii and Canada. The target audience includes Indigenous and nonIndigenous health professional educators, health practitioners, policy makers, students and community members. LIMECONNECTION VI is hosted by James Cook University and is held under the auspices of Medical Deans Australia and New Zealand, the Australian Indigenous Doctors’ Association (AIDA) and Te Ohu Rata O Aotearoa (Te ORA) - Māori Medical Practitioners Association. The Connection is an outcome of the Leaders in Indigenous Medical Education (LIME) Network Program. 1 ELIGIBILITY CRITERIA To be eligible to apply for the LIMECONNECTION VI Aboriginal, Torres Strait Islander and Māori Community Member Bursaries, candidates must: be of Aboriginal and/or Torres Strait Islander descent, identify as Aboriginal and/or Torres Strait Islander and be accepted as such by the Indigenous Australian communities in which they live or have lived; or be of Māori descent (have Whakapapa); and be actively involved in working with a Medical School. SELECTION CRITERIA Bursaries will be awarded on the recommendation of a selection committee and will be based on the following criteria: active involvement in working with Medical Schools; a demonstrated interest and experience in Aboriginal and Torres Strait Islander or Māori health; a commitment to improving Aboriginal, Torres Strait Islander or Māori health in the future; and approval of the relevant LIME Reference Group member; and community members who have submitted successful abstracts to present at LIME Connection VI will be considered first for bursary places. APPLICATION PROCESS You must submit: 1. An application form; 2. A personal statement of up to one A4 page in support of your application. Your personal statement may include a description of: how the bursary will assist you with your personal and/or professional development; your service to Aboriginal and Torres Strait Islander or Māori health or role in supporting medical education within a Medical School; and your future aspirations. 3. A signed checklist from the LIME Network Reference Group member at the university you work with (see Attachment 1 for Reference Group members). APPLICATION DUE DATE Community Bursary applications are due: 12 April 2015 Applicants will be notified of their application outcome by 28 April 2015 Applications must be received by email to the LIME Secretariat E: lime-network@unimelb.edu.au 2 SELECTION PROCESS The LIME Connection VI Bursary Committee will consider each candidate’s application against the eligibility and selection criteria. In the case that more applications than the committee can fund are judged to be equally meeting the selection criteria, the committee will also take ethnicity of the applicant into consideration, in order to ensure representation from Māori, Aboriginal and Torres Strait Islander people. The Committee’s decision will be final. The composition of the committee will include representatives from the Australian Indigenous Doctors’ Association (AIDA), Te Ohu Rata O Aotearoa (Te ORA) - Māori Medical Practitioners Association and the LIME Network Secretariat. TERMS AND CONDITIONS All successful applicants must satisfy the Community Bursary eligibility criteria (see p.2). The award of the LIME Connection VI Community Bursary is conditional on the successful applicant agreeing to provide a post-conference report to AIDA/ Te ORA, Medical Deans Australia and New Zealand and the LIME Network by 4 September 2015. The award of the LIME Connection VI Community Bursary is conditional on the successful applicant agreeing to attend conference proceedings. Delegates are expected to be present at the conference proceedings on all three days from 9-5pm. Delegates are expected to attend the Palm Island visit on Monday 10 August 2015 (organised and paid for by the LIME Secretariat). Flights and accommodation will be organised, booked and paid for by the LIME Secretariat. Successful applicants will be accommodated in twin share rooms. The LIME Secretariat will ensure that you are sharing a room with someone of the same gender. The LIME Secretariat will ensure where possible, that you are sharing a room with someone of the same age bracket. On request and in special cases the LIME secretariat may be able to organise a room to yourself – if this should happen you will need to pay half the room costs on check out. Flight and accommodation bookings are final and cannot be adjusted unless in special circumstances. In the case of cancellation, your bursary is not transferable to other community members, so we ask that successful applicants confirm their acceptance of the bursary only if they are sure they will be able to attend. The LIME Secretariat requires you to inform us of cancellations due to illness or similar as soon as possible. Flights will be organised so that bursary recipients arrive in Townsville on Sunday 9 August and leave on Friday 14 August. If successful applicants wish to stay in Townsville for longer (at their own cost) we will attempt to organise flights on different days to accommodate this. No reimbursements will be issued for flights, accommodation or other items paid for by the bursary recipients themselves – all relevant payments must be made by the LIME network. 3 1. APPLICATION FORM LIME CONNECTION VI – ABORIGINAL, TORRES STRAIT ISLANDER AND MĀORI COMMUNITY BURSARY First Name: Surname: Male Preferred Name: Home Phone: Female Mobile: Email: Home Address: Postal Address: Please indicate below whether you identify as: Aboriginal Torres Strait Islander Aboriginal & Torres Strait Islander Māori Which Medical School are you involved with? (provide location of Campus) Please briefly explain your role/s within the Medical School. Iwi Affiliations (Māori applicants): Hapū Affiliations (Māori applicants): Marae Affiliations (Māori applicants): Please indicate your age group: 18–25 26–34 35–44 45–54 55 - 64 65 + How did you hear about the Bursary? Website/Facebook Direct Email Word of Mouth University Other I hereby provide the LIME Network with permission to use images of me for promotional and marketing purposes. Yes No The LIME Reference Group member for my university has signed the checklist (below) By submitting this form I agree to abide by the Terms and Conditions as stated the LIME Network. 4 2. PERSONAL STATEMENT Write a personal statement of up to one A4 page in support of your application. This may include a description of: how the bursary will assist you with your personal and/or professional development; your service to Aboriginal and Torres Strait Islander or Māori health or role in supporting medical education within a Medical School; and your future aspirations. 5 3. LIME REFERENCE GROUP MEMBERS BURSARY APPLICATION CHECKLIST: Applicant Name: Applicant University: ☐ ☐ ☐ The applicant is an Aboriginal, Torres Strait Islander or Māori community member who works with this medical school; The applicant has demonstrated an interest in, and had experience with, Aboriginal, Torres Strait Islander and/or Māori health and medical education; The applicant will be assisted in their personal and/or professional development through receipt of the bursary. I support this community member’s application for a LIME Connection Bursary: Reference Group member name: Reference Group member signature: FOR FURTHER INFORMATION AND SUBMISSION OF THIS FORM: Erin Nicholls or Caitlin Ryan Level 2, 161 Barry Street, The University of Melbourne, VIC 3053 Email: lime-network@unimelb.edu.au Phone: +61 3 9035 8294; Web: www.limenetwork.net.au 6 ATTACHMENT 1 - THE LIME NETWORK REFERENCE GROUP MEMBERSHIP LIST University Adelaide ANU Member Dr Dylan Coleman Ms Gaye Doolan Email dylan.coleman@adelaide.edu.au gaye.doolan@anu.edu.au Phone W: 08 8303 6878 W: 02 6125 0865 e.curtis@auckland.ac.nz brad@emergencymedicine.com.au Scott.mccoombe@deakin.edu.au wendy.edmondson@flinders.edu.au W: +64 9 373 7599 W: 07 5595 4469 W: 03 5227 8382 W: 08 7221 8603 Cheryl.davis@flinders.edu.au r.west@griffith.edu.au W: 08 8946 7593 W: 07 3735 5406 donald.whaleboat@jcu.edu.au jacinta.tobin@unimelb.edu.au W: 07 4781 5126 W: 03 9908 8155 Ms Rose Gilby A/Prof Peter O’Mara Position Lecturer, Yaitya Purruna Indigenous Health Unit Coordinator of Indigenous Health and Student Engagement Senior Lecturer Medical, Director of Vision 20:20 Associate Professor Lecturer, Public Health, School of Medicine Acting Director, Poche Centre for Indigenous Health & Well-Being Lecturer, Indigenous Health Professor Indigenous Health & Workforce Development Senior Lecturer Senior Lecturer Medical Education in Indigenous Health Lecturer, Indigenous Health Unit Head of Discipline Indigenous Health Auckland Bond Deakin Flinders SA Dr Elana Curtis Dr Brad Murphy Dr Scott McCoombe Prof Wendy Edmonsdon Flinders NT Griffith Ms Cheryl Davis Prof Roianne West James Cook Melbourne Mr Donald Whaleboat Dr Jacinta Tobin Monash Newcastle Rose.gilby@monash.edu Peter.Omara@newcastle.edu.au W: 03 5022 5500 W: 02 49217734 Notre Dame Sydney Associate Lecturer Aboriginal & Torres Strait Islander Health Associate Dean Aboriginal Health Director Muru Marri Indigenous Health Unit miriam.cavanagh@nd.edu.au W: 02 8204 4491 Notre Dame Fremantle New South Wales A/Lecturer Miriam Cavanagh Prof David Paul Prof Lisa Jackson Pulver David.paul@nd.edu.au l.pulver@unsw.edu.au W: 08 9433 0525 W: 02 9385 1769 Otago Queensland A/Prof Suzanne Pitama Dr Maree Toombs suzanne.pitama@otago.ac.nz m.toombs@uq.edu.au W: +64 3 364 3635 W: 07 4633 9716 Sydney Tasmania Western Australia Dr Lilon Bandler Dr Maureen Davey Assist/Prof Craig Allen lbandler@sydney.edu.au Maureen.davey@utas.edu.au Craig.allen@uwa.edu.au W: 02 9036 7577 W: 03 6226 4661 W: 08 6488 8140 Western Sydney Wollongong Ms Christine Carriage Dr Scott Winch Maori Health Lecturer and Director MIHI Director, Indigenous Health, School of Medicine Rural Clinical School Senior Lecturer in Indigenous Health Education Senior Lecturer in Medical Practice Assistant Professor, Centre for Aboriginal & Medical Dental Health Indigenous Program Officer Academic Leader, Indigenous Health c.carriage@uws.edu.au swinch@uow.edu.au W: 02 4620 3637 W: 02 4221 5629 7