Funding to Support Continuing Professional

Application Form

Funding to support Continuing Professional

Development (CPD)

Please refer to guidance notes before completing form.
Please note: if you are a member of AIC you must apply to FAIC for this funding.

Section 1: Personal details

Forename / Click here to enter text. /
Surname / Click here to enter text. /
Street address / Click here to enter text. /
City, State/Province, Postal Code,
Country / Click here to enter text. /
Phone number
(including Country code) / Click here to enter text. /
E-mail address / Click here to enter text. /
Icon Membership / Choose an item.
Membership number if yesClick here to enter text.
ACR Status / Choose an item. /

Section 2: Employment details

Organisation / Click here to enter text. /
Job title / Click here to enter text. /
Date of joining / Click here to enter text. /
Line manager / Click here to enter text. /
Line manager role / Click here to enter text. /
Relevant training and employment
Please attach a copy of your CV to this application. / Institution / From / To / Qualification
Click here to enter text. / Click here to enter text. / Click here to enter text. /
Click here to enter text. / Click here to enter text. / Click here to enter text. /
Employer / From / To / Job title
Click here to enter text. / Click here to enter text. / Click here to enter text. /
Click here to enter text. / Click here to enter text. / Click here to enter text. /

Section 3: Project summary

Project title / Click here to enter text. /
Project dates and location / Click here to enter text. /
Please provide a brief summary of the activity.
No more than 200 words. / Click here to enter text. /
Event / conference organiser / Click here to enter text. /
Event / conference website / Click here to enter text. /
Have you previously applied for funding? / Click here to enter text. /
If yes, how much was it for and when was it awarded? / Click here to enter text. /

Section 4: Project benefits

How will the CPD event keep you informed on changes in the profession as well as broader developments relevant to your work context (40%)
No more than 200 words. / Click here to enter text. /
How will the CPD event ensure that your practice, knowledge, skills and techniques are up-to-date, both at a general level and in relation to individual projects and tasks that you undertake.
No more than 200 words. / Click here to enter text. /
How do you intend to use this CPD event to support your personal career development needs.
No more than 200 words. / Click here to enter text. /

Section 5: Project Costs

Ensure that you provide accurate costs. If successful, you will be required to submit receipts for the costs shown.Do not include costs which are being waived, or paid for, by the event organiser.If the actual cost of fees, travel, or accommodation is less than listed here, a repayment of the difference (proportionate to the % value of our bursary) will be required.

Please ensure you include the currency your costings are worked out in.

Total fees / Click here to enter text. /
Total accommodation cost / Click here to enter text. /
Total travel cost / Click here to enter text. /
Total activity cost / Click here to enter text. /
Employer contribution / Click here to enter text. /
Personal contribution / Click here to enter text. /
Total grant request / Click here to enter text. /

Section 6: Application history

Have you applied previously for a Tru Vue / Icon grant? / Choose an item. /
If yes, when did you apply? / Click here to enter text. /
If yes, were you successful? / Choose an item. /

Section 7: Referees

Name / Click here to enter text. /
Organisation / Click here to enter text. /
Position / Click here to enter text. /
Relationship to you. / Click here to enter text. /

Declaration

I declare the information submitted in this application is accurate and truthful. I recognise that failure to submit accurate information will result in my application being dismissed. ☐

Please tick here if you are happy for your contact details to be shared with Tru Vue. ☐

Signature / Click here to enter text. /
Full name / Click here to enter text. /
Date / Click here to enter text. /

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