Guidelines and Application for Grants

Scholarship Application Form

Further information concerning the Australian College of Midwives Scholarships can be obtained from:

Australian College of Midwives

PO Box965

Civic Square ACT2608

e-mail:

Or by visiting the ACMwebsite:

ACM Scholarship Application Form, v1, endorsed 9/08/2017Page 1 of 5

ACM Scholarship Application Form

GeneralInformation

Scholarship specific eligibility requirements, selection criteria, and terms and conditions of scholarships are set out on the ACM website:

The amount of financial or in-kind assistance granted in any year, and the number of applicationsamong which the available moneys will be distributed, are at the absolute discretion of the ACM.

Submissionsonthisprescribedapplicationform accompanied by the required supporting documentationmustbereceivedbytheACM no later than the given deadline advertised on the ACM website.

Completed applications and particulars requested are to be emailedto:

ACM Scholarship Application Form, v1, endorsed 9/08/2017Page 1 of 5

ACM Scholarship Application Form

Scholarship ApplicationForm

Full Name
Date of Birth
Address
Phone
Email
Scholarship Applied for
Total Amount Requested
ACM Membership
Are you a current member of the ACM? Yes☐ No☐
What type of membership do you currently have? Full ☐Student ☐Graduate ☐
How many years/months have you been a member of the ACM? ☐Years ☐Months
ACM Branch
Which ACM Branch are you a member of? ACT☐ NSW☐ QLD☐ NT☐ WA☐ SA☐
Gippsland☐VIC☐ TAS☐
Have you received an ACM scholarship in the last two years? Yes ☐ No ☐
If ‘Yes’, please describe the scholarship and nature of the funding you received:
Have you defaulted on the terms and conditions of an ACM scholarship previously awarded?
Yes ☐ No ☐
If ‘Yes’, please describe the nature and reason for the default:
Participation in ACM Activities
If you are a full ACM member, please provide information about your participation in ACM activities over the last two years
Other financial support, paid leave, or other benefits
Please provide details of any other financial support, paid leave or other benefits received in relation to the activity or project described in this scholarship application
Referee Details
Atleasttwotobeprovidedwhohaverecentknowledgeofyourprofessionalwork
Name / Position / Email / Phone
Title:
Short title of your project/activity/event, for reference incorrespondence
Description of project, activity or event
Please provide a plain language description of yourproject/activity/event
Budget
Please provide a working budget for your project/activity/event
Literature Review (if applying for a research scholarship)
Please provide a summary of your literature review
Research Design(if applying for a research scholarship)
Please provide an outline of your research design and description of proposed methods
Ethics Approval (if applying for a research scholarship)
Please provide information about name of organisation where the research will be undertaken and evidence of ethics approval from the organisation.
Additional Items
Please provide any additional items required by specific scholarships egBranch scholarship requirement for essay about the benefit of a scholarship to your practice

Please attach the following additionalinformation to your application email:

1.A summarised curriculum vitae (maximum length two (2) A4 pages);

2.EvidenceofapprovaltoyourprojectfromaninstitutionalorcommunityEthicsCommittee (where relevant).

ACM Scholarship Application Form, v1, endorsed 9/08/2017Page 1 of 5

ACM Scholarship Application Form