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Cotton Industry Medical Scholarship

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Cotton Industry Medical Scholarship

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									                                                                                                                                                                                2010
                                                                                                                                                                                S CH O L A R S H I P
Where you grew up                                                                                                                                                               I N FORM At I O N
                                                                                                                                                                                & APPLICAtION
1. For each phase of your life name the town (or
nearest town) where you spent the majority of your time.
If not in NSW, please also nominate the State.
If you lived overseas, also list the country and give
the approximate population of the relevant towns.

Early childhood (< 5 years of age)

                                              Years

Primary schooling (5 –12 years of age)

                                              Years

Secondary schooling (13–16 years of age)

                                              Years

Senior secondary (17 & 18 years of age)
                                                           For enquiries regarding the Cotton Industry
                                              Years        Medical Scholarship, please contact
                                                           Marie Kelliher –
2. If you grew up in a metropolitan area, did you
regularly visit non metropolitan areas prior to going      Tel     02 8337 8100
to university?                                             Fax     02 8337 8110
   Not applicable     No      Yes                          Email   students@nswrdn.com.au

3. Has your spouse or partner ever lived in a              Completed applications can be emailed,
non metropolitan area?
                                                           faxed or posted to:
   Not applicable     No      Yes
                                                           Marie Kelliher
If yes, please indicate the number of years                Project Officer – Education & Training                      NSW Rural Doctors Network
                                                           NSW Rural Doctors Network                                          PO Box 1111
                                                           PO Box 1111                                                     Mascot NSW 1460
To complete your application
                                                           Mascot NSW 1460                                                   Tel 02 8337 8100
Please attach the following information:                                                                                     Fax 02 8337 8110
a) Proof of enrolment for 2010                             Applications must be received by                           Email students@nswrdn.com.au
b) Resume                                                  5pm Friday 9 April 2010
c) A short essay answering the following question:
                                                           Hard copy applications should NOT be stapled.
    ‘What do you hope to achieve by holding the 2010
    Cotton Industry Medical Scholarship?’                                                                            www.nswrdn.com.au               Cotton Industry Medical Scholarship
    (300 word minimum – 500 word maximum)


                                                                                                           RDN4513
What is the Scholarship?                               How are payments made?                                Who is eligible?                                           2010 Cotton Industry Medical
The Scholarship will provide a student studying        The selected student will receive financial support   Applicants must be an Australian or New Zealand
                                                                                                                                                                        Scholarship Application Form
at an Australian Medical School with $5,000 per        in three payments. Payments are made prior            citizen or a permanent resident of Australia and be        Family name ___________________________________
year for three years to assist with costs associated   to placements and on completion of the two            studying medicine at an Australian medical school.         Given name(s) _________________________________
with their studies.                                    week placement period following submission
                                                                                                             Applicants must be enrolled in:                            Gender _______________________________________
                                                       of an evaluation. Students not honouring their
In return, the student is required to spend two                                                              •	 2nd	year	of	a	post	graduate	medical	degree;             Date of birth _______________________ Age _______
                                                       commitment to undertake rural placements will be
weeks on a rural placement per year in a NSW           required to pay back all money granted to them.       •	 3rd	year	of	a	five	year	medical	degree;	or	             Student number ________________________________
cotton growing region during their university                                                                •	 4th	year	of	a	six	year	medical	degree.                  University _____________________________________
holidays. Placement programs reflect the enjoyable
aspects of rural health practice.                         AREA MAP                                           Applicants must demonstrate:                               University year _________________________________

                                                                                                             •	 an	understanding	of	the	realities	of	rural	medical			   term address __________________________________
The scholarship is funded and supported by the
Gwydir Valley Cotton Growers Association. It is                                                                 practice (both positive and negative)                   ______________________________________________

administered by the NSW Rural Doctors Network.                                                               •	 the	motivation	to	undertake	placements	in	a		       	   Mobile ________________________________________
                                                                                                                cotton growing area                                     term telephone ________________________________
                                                                                                             •	 an	understanding	of	the	cotton	industry	and/or	be		
                                                                                                                                                                        Permanent address _____________________________
                                                                                                                from a cotton growing area
                                                                                                                                                                        ______________________________________________

                                                                                                                                                                        ______________________________________________
                                                                                                             How to apply?
                                                                                                                                                                        Permanent telephone ___________________________
                                                                                                             Complete the attached registration form and return.        Email _________________________________________
                                                                                                             Additional registration forms and selection criteria can
                                                                                                                                                                        Are you an Australian or New Zealand citizen or
                                                                                                             be found at www.nswrdn.com.au
                                                                                                                                                                        permanent resident of Australia?

                                                                                                                                                                            Yes        No

                                                                                                                                                                        Are you an Aboriginal or torres Strait Islander?

                                                                                                                                                                            Yes        No

                                                                                                                                                                        Signature _____________________________________

                                                                                                                                                                        Date__________________________________________
                                                              The Cotton Industry Medical Scholarship
                                                              provides for a rural medical placement in
                                                              the Moree cotton growing area.

								
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