GOING RURAL HEALTH
MASTERS OF PSYCHOLOGY – BURSARY
SUPPLIER NUMBER: ______
Entered into Locked Spreadsheet / ApprovedEntered on FMP / Declined
Student Information
Surname: / First Name:
Mailing Address / Phone Number:
Street: / Email:
City/Town: / State: / Postcode:
Discipline: / Graduate Entry Masters / UOM Accommodation Used Yes / No
Education Provider:
International Student? / Yes
(not eligible) / No
Identify as Aboriginal or Torres Strait Islander? / Aboriginal / Torres Strait Islander / Both Aboriginal and Torres Strait Islander / Neither
Clinical Placement Location:
Application Received: / Survey Completed: / YES / NO
Date of Placement: / Commenced: / Completed: / Total Number of Placement Days:
External Students
Internal Students / F04 / F07
F06
Approved For: / 40 Day Placement Bursary ($3000) / 60 Day Placement Bursary ($4500)
Instalment payments can be made in retrospect, as long as requirements for the most recent instalment have been met. ie. If application is received half way through placement the mid-point Proof of Placement along with F04 is all that is required.
Commencement / Midpoint Date / Completion Date
Instalment / Date / Amount / Requirements Met / Sent to Finance (Date and Signature)
Instalment 1 /
- Letter of placement acceptance
Instalment 2 /
- Proof of Placement
Instalment 3 /
- Survey
- Proof of Placement
- Brief written evaulaiton
Comment:
Eligibility Check:Therese Cossens ______Date: ______
Themis Account String: / 01 5870 00 5665 056711 GEN 13 07
F 07
/AP Imaging Payment Request
Going Rural Health – Masters of PsychologyBursary Payment 1 /
This form is to be used to initiate a payment through the AP Imaging system when no official invoice documentation exists from the supplier. This is NOT to be used for payment to Students or Employees. There are separate AP Imaging requests for Visitors and Honoraries. The information entered into this form should be typed.
1. Department Details
Department No:
/5870
/Date of Request:
Location:
/RURAL HEALTH - SHEPPARTON
Rural Health Multidisciplinary Training Programme – Going Rural Health Student Support Scheme /No. of Pages (inc cover sheet):
Are you making a payment to a:
/Visitor orSupplier (with no official invoice)
Note: if this is a reimbursement supported by receipts, please tape the receipts to an A4 sheet of paper and attach to this cover sheet.- PAYMENT DETAILS
Supplier Number:
Supplier Name:
Payment Amount:
(inc applicable GST)
GST Tax Amount: / NIL
Payment Currency: / X aud USD EUR GBP NZD JPY SGD CAD CHF HKD INR
MYR CNY IDR
GST Treatment: / GST XFree-GST
Description of Payment: / Dept. of Rural Health, Rural Health Multidisciplinary Training Programme supports Allied Health and Nursing Students across all Universities as funded by the Commonwealth. This payment is part of the Going Rural Health Student Support Scheme assisting in the financial expenses of completing a rural clinical placement.
Themis Account String: / Co / Dept / CC / Account / Project / LPC / Activity / Loc
01 / 5870 / 00 / 5665 / 056711 / GEN / 13 / 07
Special Instructions:
(if applicable) / APPROVER: KERYN BOLTE – GOING RURAL HEALTH PROGRAM
Upon completion, please attach any relevant documentation and forward to
Accounts Payable, Finance & Planning Group for scanning.
F 07
/AP Imaging Payment Request
Going Rural Health – Masters of Psychology Bursary Payment 2 /This form is to be used to initiate a payment through the AP Imaging system when no official invoice documentation exists from the supplier. This is NOT to be used for payment to Students or Employees. There are separate AP Imaging requests for Visitors and Honoraries. The information entered into this form should be typed.
1. Department Details
Department No:
/5870
/Date of Request:
Location:
/RURAL HEALTH - SHEPPARTON
Rural Health Multidisciplinary Training Programme – Going Rural Health Student Support Scheme /No. of Pages (inc cover sheet):
Are you making a payment to a:
/Visitor orSupplier (with no official invoice)
Note: if this is a reimbursement supported by receipts, please tape the receipts to an A4 sheet of paper and attach to this cover sheet.- PAYMENT DETAILS
Supplier Number:
Supplier Name:
Payment Amount:
(inc applicable GST)
GST Tax Amount: / NIL
Payment Currency: / Xaud USD EUR GBP NZD JPY SGD CAD CHF HKD INR
MYR CNY IDR
GST Treatment: / GST X Free-GST
Description of Payment: / Dept. of Rural Health, Rural Health Multidisciplinary Training Programme supports Allied Health and Nursing Students across all Universities as funded by the Commonwealth. This payment is part of the Going Rural Health Student Support Scheme assisting in the financial expenses of completing a rural clinical placement.
Themis Account String: / Co / Dept / CC / Account / Project / LPC / Activity / Loc
01 / 5870 / 00 / 5665 / 056711 / GEN / 13 / 07
Special Instructions:
(if applicable) / APPROVER: KERYN BOLTE – GOING RURAL HEALTH PROGRAM
Upon completion, please attach any relevant documentation and forward to
Accounts Payable, Finance & Planning Group for scanning.
F 07
/AP Imaging Payment Request
Going Rural Health – Masters of PsychologyBursary Payment 3 /
This form is to be used to initiate a payment through the AP Imaging system when no official invoice documentation exists from the supplier. This is NOT to be used for payment to Students or Employees. There are separate AP Imaging requests for Visitors and Honoraries. The information entered into this form should be typed.
1. Department Details
Department No:
/5870
/Date of Request:
Location:
/RURAL HEALTH - SHEPPARTON
Rural Health Multidisciplinary Training Programme – Going Rural Health Student Support Scheme /No. of Pages (inc cover sheet):
Are you making a payment to a:
/Visitor orSupplier (with no official invoice)
Note: if this is a reimbursement supported by receipts, please tape the receipts to an A4 sheet of paper and attach to this cover sheet.- PAYMENT DETAILS
Supplier Number:
Supplier Name:
Payment Amount:
(inc applicable GST)
GST Tax Amount: / NIL
Payment Currency: / Xaud USD EUR GBP NZD JPY SGD CAD CHF HKD INR
MYR CNY IDR
GST Treatment: / GST X Free-GST
Description of Payment: / Dept. of Rural Health, Rural Health Multidisciplinary Training Programme supports Allied Health and Nursing Students across all Universities as funded by the Commonwealth. This payment is part of the Going Rural Health Student Support Scheme assisting in the financial expenses of completing a rural clinical placement.
Themis Account String: / Co / Dept / CC / Account / Project / LPC / Activity / Loc
01 / 5870 / 00 / 5665 / 056711 / GEN / 13 / 07
Special Instructions:
(if applicable) / APPROVER: KERYN BOLTE – GOING RURAL HEALTH PROGRAM
Upon completion, please attach any relevant documentation and forward to
Accounts Payable, Finance & Planning Group for scanning.
Student Support Scheme – Processing FormVersion19/09/2017
Author – Therese Cossens