NameThis field is for validation purposes and should be left unchanged.APPLICANT FORM Professional Development Awards The David Collins Leukaemia Foundation of Tasmania calls for applications for professional development bursaries in blood cancer related treatment. Applications are open to Tasmanian health professionals working Statewide. Awards up to $1,500 will be given to assist applicants to participate in or organise an approved conference or seminar recognised by their appropriate peer organisation and directly related to the improvement of blood cancer treatment or patient support. Awards may be used to assist with conference registration and accommodation, but excludes air fares and travel. However, airfares for invited speakers will be considered. APPLICATION SUBMISSION: Applications must include full costing and be accompanied by letters of support from two referees. Awards are at the discretion of the DCLFtas Board and are granted on a case by case basis. PREFERENCE WILL BE GIVEN TO APPLICANTS: Who demonstrate that the knowledge and skills acquired will be shared with their Tasmanian colleagues and others concerned with blood cancer treatment or support Who propose co-funding arrangements (e.g. part employee, part employer) With a subject matter focus on patient care and/or new technical skills e.g. emerging technologies and therapies relevant to this field of haematology. SUCCESSFUL APPLICANTS WILL BE: Required to provide a brief plain English written report for possible release to Tasmanian media and publication in the DCLFT Newsletter and Annual Report Expected to accept an invitation, within a reasonable time, from DCLFtas to attend a meeting of members and discuss in a relaxed environment the benefits to patients and staff arising from their Award. SEND COMPLETED FORM TO: professionaldevelopmentawards@DCLFtas.org.auPERSONAL DETAILS:Name(Required) Dr.MissMr.Mrs.Ms.Mx.Prof.Rev. Prefix First Last CI Email(Required) Position(Required)Institution(Required)Address(Required) Street Address Suburb ZIP / Postal Code CONFERENCE DETAILS:Courses/Conference Title(Required)Relationship to blood cancer treatment(Required)Patient Care focus and/or emerging technical skill focus(Required)Dissemination of knowledge gained?(Required)If attending conference, are you presenting an abstract? (yes/no)(Required) Yes No Is this professional development co-funded? (yes/no)(Required) Yes No If yes (cofunded), by whom and to what extent?Attach conference program, course outline or supporting documentsAmount sought(Required)Amount funded (for office use)
