Post Graduate Education Funding (HWNZ Funding) Application form for Registered Nurses employed within Counties Manukau Health Funding Area

Last Day for Application: 24th September 2017

IMPORTANT: This form is best viewed in Firefox.

IMPORTANT: You must complete this form in one sitting.

You cannot save the form and return to it. If you would like to outline your answers you can download a copy of this form.

NOTES:

Your line manager(s) must support your application.

Email will be the main form of contact.

All Applicants must have completed a career plan with their line manager before applying for HWNZ funding.

You will need to apply for funding every semester. If your application is successful it is only for Semester one.

You will be notified of application results by 30th November 2017

CRITERIA:

Be a registered nurse and hold a current New Zealand Nursing Council’s Annual Practising Certificate.

Be employed in a permanent (part or full time) nursing position in a health service that is funded by Counties Manukau Health or the Ministry of Health from Vote Health monies.

Be a New Zealand Resident or Citizen.

Be compliant with the organisations Professional Development and Recognition Programme (PDRP) [if applicable to organisation].

If commencing postgraduate diploma or Masters then must be proficient, expert or senior level on the PDRP.

Career plan completed.

Priority given to high workforce development needs as identified by MOH and CM Health strategic and workforce development documents.

Preference given to applicants completing their qualification.

Papers must be level 8 and be able to be credited towards a Masters of Nursing programme approved by the New Zealand Nursing Council.

Health Practitioner Registration Number(Required)

Note: Annual Practising Certificate (APC). You must be a registered nurse.

Trainee first name(Required)

Note: First name as it appears on your APC.

Trainee surname(Required)

Note: Surname as it appears on your APC.

Employer Name(Required)

Note:CMDHB employees, type Counties Manukau DHB. Non-CMDHB employees, type your Employer’s name.

Do not use abbreviations.

Ethnicity(Required) Dropdown box

Iwi/Hapu

Note: Leave spaces between multiple entries. Do not use brackets or commas.

Gender(Required) Dropdown box

Date of Birth(Required)

Note: format DD/MM/YYYY

NZ Citizen/Permanent Resident(Required)

Note: The training specification says you must be a NZ Citizen or hold a NZ Residency Permit.

(No unable to proceed!)

Maori or Pacific Peoples SupportDropdown box

Would you like additional funding for mentoring and/or cultural supervision?

Note: Maaori and Pacific funding is available to provide you with mentoring and cultural supervision. It can also be used for Cultural development resources (up to a maximum of $200). A formal mentoring plan must be completed as part of this. Contact the Post Registration/PDRP Lead PGE for further details

Select either Maori = CTMS or Pacific = CTPS

Clinical Service Area(Required) Dropdown box

Educational Planned

Note: If undertaking a Postgraduate Diploma must be at Proficient level or higher. If commencing a Masters a discussion must be held with CND/Nurse Leader, CNM/CMM/TL, NE and/or Post Registered/PDRP Lead.

Date Commenced Training(Required)

Note: Date you started studying. Format DD/MM/YYYY

Qualification sought(Required)Dropdown box

Note: The programme you have enrolled in.

Education Provider(Required)Dropdown box

Note: University/Technical Institute.

Provide details of the paper you require funding for in Semester 1. 2018

Paper 1 Number (Required)

Paper 1 Title(Required)

Paper 2 Number

Note: If applicable.

Paper 2 Title

Note: If applicable.

Expected Completion Date(Required)

Note: Date you will finish studying. Format DD/MM/YYYY

Travel BandDropdown box

Do you need travel and accommodation subsidy?

Note: Travel and accommodation is only available if you need to travel more than 100Kms from place of work one way (excluding Wintec in Hamilton for CMHealth staff).

Month Answer: 01/03/2018 Hidden Question. Need formula i.e. DD/MM/YYYY – do not want the system to add the day

Employment FTE(Required)Dropdown Box

80hrs a fortnight = 1

72hrs a fortnight = 0.9

64hrs a fortnight = 0.8

56hrs a fortnight = 0.7

48hrs a fortnight = 0.6

40hrs a fortnight = 0.5

32hrs a fortnight = 0.4

Student ID

Papers planned to complete Qualification(Required)

Note: Type None if no papers planned.

Research Focus

Note: If applicable.

Number of Days Education Leave Required(Required)

Work Details

Work Area(Required)

Note: Name of ward, unit, etc.

Is this a Primary Healthcare Organisation?(Required)

(No go to ‘Service Area’ Question)

Yes(Required)Dropdown box

Service Area(Required)Dropdown Box

Work Email Address (Required)

Mobile Phone(Required)

Do you work in more than one area?(Required)

(No go to ‘Years employed in current role(s)’ Question)

2nd Work Area(Required)

Note: Name of ward, unit, etc

Years employed in current role(s) (Required)

Educational Record

Is this your first submission? (Required)

(No go to ‘Have you received any educational funding before’ Question)

New Zealand Passport Number / Citizenship or Residency Visa Number(Required)

Please email a copy for evidence to Geraldine or Dianne

Have you received any educational funding before?(Required)

(No go to ‘PDRP’ Questions)

YES

Was it from HWNZ? (Required)

(No go to ‘Was it from NETP?’ Question)

Semester, Year (Required)

Was it from NETP?(Required)

Semester, Year (Required)

Professional

Professional Development and Recognition Programme

If your organisation has PDRP then you must be compliant with this to receive HWNZ funding. Compliancy will be checked.

PDRP Level(Required) Dropdown box

Full Portfolio Due Date(Required)

Note: Formula DD/MM/YYYY

Prescribing Practicum in 2018

Are you taking a prescribing practicum in 2018?(Required)

(No go to Line Manager Questions)

Yes

Must be discussed with your CND/Nurse Leader

Note: It is the expectation of CM Health that if the supervisor is an employee of CM Health then the supervision will be undertaken within work time and therefore require no additional funding.

Clinical Access Hours Required(Required)

Clinical Supervisor Name(Required)

Costs of supervision(Required)

Please provide your Line Manager’s details

Line Manager Name(Required)

Line Manager Email(Required)

Applicant Agreement

Do you agree to the following terms?

I agree (Required)

  • I have completed a career plan as part of my performance review process.
  • I will enrol within the university timeframes.
  • I will notify the Post Registration/PDRP Lead PGE in writing of ANY changes in my enrolment.
  • Unsuccessful completion of the Post Graduate Qualification (for reasons other than those beyond fair and reasonable causes) may result in CM Health retrieving the monies (see policy).
  • CM Health may seek confirmation of course completion and results from the university/technical institute involved.
  • CM Health may release my details to HWNZ in accordance with the Privacy Act (1993).
  • My name may be provided to other students so they can contact me to discuss the papers I have completed or am currently undertaking.
  • I understand that if I do not meet the criteria stated above, I may not receive funding.
  • I agree that if I am unsuccessful in my application, my name can be placed on a waitlist.
  • I agree to participate in any Post Graduate Education evaluation as requested.

*** Notice Received once sent***

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