Office of Human Resources

Application for Vice-Chancellor’s Professional Development Scholarships -

Aboriginal and Torres Strait Islander Staff 2017

AcademicProfessional

SECTION A / PERSONAL DETAILS
Staff Id Number / Contact Number
Name (incl title)
Email Address
Years of continuous employment at Western Sydney
Full Time/Part Time:
Briefly describe the activity that you wish to attend: ______
______
DECLARATION
In completing this application I declare that:
  • I am of Australian Aboriginal descent and/or Torres Strait Islander descent; and
  • I Identifyas an Australian Aboriginal and/ or Torres Strait Islander person; and
  • I am accepted as an Australian Aboriginal and/ or Torres Strait Islander personinthe community in which I live or have lived.
I declare that I am (please tick):
Aboriginal / Torres Strait Islander / Both Aboriginal and Torres Strait Islander
Please indicate if you have provided evidence conforming to the above (please tick):
This is an Identified Aboriginal and/or Torres Strait Islander scholarship.
You are required to have provided documentation in relation to Proof of Aboriginal and/or Torres Strait Islander Status (as per Section 5 of Western Sydney University’s Recruitment and Selection Policy).
Held in my employment file by the Office of Human Resources / Provided as an attachment to this application
Name:
Signature:
Date:
CURRENT POSITION DETAILS
Position Title / Level
Name of School or Unit / Campus
Name of Supervisor
Name of Director/ Executive Director/Dean of School
Details of ALL professional development activities and conferencesattended over the past 4years (both Western SydneyUniversity and external to Western Sydney University ):
Date / Activity / Training/Organisation/Conference Details / Funded by University or Self Funded?
NOTE: Applications will only be considered for activities from 1 January 2017 to 31 December 2017
SECTION B / DETAILS OF THE PROFESSIONAL DEVELOPMENT ACTIVITY FOR WHICH FUNDS ARE BEING SOUGHT
Is your application for -

Conference attendance? Yes (Complete Section 1)

Workshop, seminar or short course attendance? Yes (Complete Section 2)
  1. CONFERENCE
What is the title of the conference?

Have you submitted a paper for presentation at the conference? Yes No
If yes, please attach a copy of the abstract.
Please provide a web link address for the conference site.
When/where will the conference be held?
Date: City: Country:
Proceed to Section C
  1. WORKSHOPS, SEMINARS OR SHORT COURSES

This application is for a Workshop Seminar Short Course
Whatis the title of theactivity?
Please provide (insert) or attach a description of the activityor provide a web link to the information.
Proceed to Section C
SECTION C / COST OF ACTIVITY
Please provide full details of costs, including course fees/conference registration fees, travel and accommodation costs (if applicable) and incidental costs.
Amount $
Conference Registration Fee
Course / Activity Fee
Accommodation
Airfares
Meals / Incidentals
Other (Please specify)
Total:
If the scholarship does not meet the full costs of the proposed activity, how will the balance be paid?
Have you or will you receive any support or funding for this activity from any other source (Western Sydney or external)?
Yes No
If yes, please provide details:
YOUR REASONS FOR APPLYING FOR A SCHOLARSHIP
1. / Could you tell us about your Aboriginal and/ or Torres Strait Islander people and community ambassadorship?
2. How will the scholarship benefit your career and professional development?
3. / Academic Staff: / How is the proposed activity relevant to your teaching and or research?
Professional Staff: / How is the proposed activity relevant to your current position?
4. / What are your expectations from attendance at the proposed activity?
5. / Briefly descibe how this professional development activity is relevant to your career development plan as discussed with your supervisor and documented through the Compass Program. (Max 100 words) Provide a copy of this documentation.
6. / What are your proposed outcomes and actions for sharing your activity experience with your Western Sydney University colleagues?
7. / Is there anything further you wish to add in support of your application?
NOTE:
IMPORTANT / If your application is successful, you will be required to submit a brief report on the outcomes of your activity to Terri Keating (max 300 words) within 1 month of completing the activity and also to undertake a presentation or publication on your outcomes.
A letter of support from your Dean/Executive Director/ Director must be attached to this application – see appendix A
Please submit your application by email attachment to:
Vice-Chancellor’s Professional Development Scholarships
Office of Human
By close of business Monday 20February 2017
For more information about completing this application please contact the Office of Aboriginal and Torres Strait Islander Employment and Engagement on 02 9678 7587 or email .
Please note recipients of a Vice-Chancellor’s Professional Development Scholarship are not eligible to apply for a scholarship in the year following the award of the scholarship.
NOTE: This application will be acknowledged by email within 48 hours. If you do not receive acknowledgement, please phone Kahlia Butcher on ext 7066.

APPENDIX A

STATEMENT OF SUPPORT – Dean/ Executive Director / Director / PVC/DVC & VP / VP
1. / Please state reasons for supporting this application
2. / Please state benefits or value add that this activity will have to the staff members’ career and professional development?
3. / Please state the benefits or value add that this activity will have to the organisational unit?
4. / What other support or funding if any, will your Unit/School provide?
I support this application for the Vice-Chancellor’s Professional Development Scholarship
Name:
Position:
Signature:
Date:

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