HWNZ Funding Application for Postgraduate Nursing Education

Instructions :
This form must be submitted. No Written applications will be accepted.
Funding is for programmes of study that lead to level 8 qualifications on the National Qualifications Framework.
To access funds please read the Postgraduate Funding Information on the link below.
  • This application covers the entire academic year, Semesters 1 and 2
  • Organisational support must be obtained in order to access this funding.
  • Please complete all relevant sections in this application form.
  • Note - Late applications are only considered on a case by case basis at the discretion of the HWNZ Funding Coordinator.
  • All applicants will be notified on the decision as soon as possible. All applications will be reviewed by the CNM and CNL against the criteria for selection.
  • Enrolment with the Tertiary Education Provider is a separate process requried of the appicant. Please submit an enrolment with your Tertiary Education Provider.
Note : Please complete the Career Plan for Registered Nurses form BEFORE starting to complete the following HWNZ Funding Application.
You will neeed to Upload this file during Section I.
 
Applications close 28th October 2011
If you have questions please contact :
Liz Buckley, Nurse Cooordinator Practice Development
BOPDHB, (07) 579-8368 or (021) 472-843 or email : liz.buckley@bopdhb.govt.nz
BOP DHB Funding Link
Fields with a * are mandatory and must be filled in .
Please make sure you read this form as you complete it.

Section A.
Applicant Information
Surname :    *
  		First Name :    *
 
Surname :(as on APC) First Name :(as on APC)
NCNZ Registration Number :    *
  		Gender :    *
 
DOB :
  *
 
   
Best Contact Number : Work Phone :
Email Address :
Confirm Email Address :
  *
      		Ethnicity :    *
 
Alternate Email Address :   Iwi :
Are you a NZ Resident :  
Section B.
Employment Information
Some funding is also available to provide cultural and professional supervision/mentoring for Maori and Pacific Trainees. Please apply during the funding round.
Name of Employer :
Role Title :
Fortnightly FTE :
PDRP Level :    
DHB Employees
Line Manager :
Clinical area of practice

DHB Postal Address i.e ICU
Non DHB Employees - PHO, NGO, Aged and Resifential Care, Plunket
Clinical area of practice/speciality

Full Postal Address i.e. P.O Box Address :
Section C.
Postgraduate Qualification Level.
Please make sure your READ below before completing Tables D and E.
Postgraduate study must be approved by the Nursing Council of New Zealand (NCNZ)or be able to be credited towards a NCNZ approved qualification.
Click here to refer to www.nursingcouncil.org.nz for a list of approved degree programmes.

NOTE: Please refer to the levels of Postraduate Qualifications figure below before completing Tables D and E.

* If undertaking study after completing a Nursing Masters Degree, please proceed to Table F: PostMasters Programme

Click here to refer to www.nursingcouncil.org.nz for a list of approved degree programmes.
I have checked that my paper/course can be used as part of a NCNZ approved qualification :
Please indicate the qualification level you will obtain at completion of 2012 study( see figure in section C) :

Will you complete this qualification in 2012 ? :
Section D.
Qualification Level : List  completed  papers within each qualification level that build towards your current qualifications.
Qualification Year Paper Number/Code University Select the Name of your Paper Paper credit value Grade
Postgraduate Certificate
(Level 1)


Postgraduate Diploma (Level 2)
Postgraduate towards Masters (Level 3)
Postgraduate Masters Degree
(Level 4 - Usually final two papers)
Section E.
2012 Paper Enrollments. List Papers you are enrolling in for 2012 (both semesters)
Paper Code University Select Paper Name Paper Length by Semester Semester you wish to study in Paper Point Value
Thesis Dissertation :
If you are planning to undertake or are completing a research thesis, please briefly outline the topic and relevance to service.
Will you complete your current programme level this year ? If NO please indicate when you will complete the qualification : dd/mm/yyyy
Level Four Programme Practicum Paper
If you are planning to undertake a prescribing or non-prescribing practicum paper to complete your degree in 2012, a practicum support plan must be prepared before commencing the paper
Are you enrolling in a prescribing or non-prescribing practicum for this coming year.
If yes please contact the HWNZ Funding Coordinator - Liz Buckley via email liz.buckley@bopdhb.govt.nz 		Draft Practicum Support plan completed.
To access support to prepare a Practicum Support Plan please contact liz.buckley@bopdhb.govt.nz
A Practicum Support Plan will address the additional expectations of Clinical teaching/preceptorship (often medical), mentoring and professional supervision often associated with these papers. HWNZ funding subsidises some of the additional costs associated with completing a Nurse Practitioner prescribing practicum
Section F.
Post Masters Programmes of Study/Qualifications. This section asks about this years enrolments towards a Post-Masters programme of study/qualifications
Masters Degree Qualification Name :
University
Year Conferred :
Section G.
Rationale for Study and Professional Development (Career) Plan
You must have a career plan to be able to access HWNZ funding – this can be developed by creating an account on Midland e learning site at the following link and enrolling in the Career plan nursing course.
Have you completed a Career Plan ?
A Career Plan is Required for all Postgraduate Funding Applications
Have you a current portfolio (PDRP)
Section H.
Funding.
Funding provides tuition and compulsory fees charged by the tertiary education provider (please list approximate costs of each paper number/code if more than one).
Paper Code e.g. NURSING 706 University Paper Name Estimated Cost per paper (Based on 2011 costs if 2012) Number of study days required per paper
Travel (conditions apply) - Actual costs for trainees required to travel further than 100kms by road one way from the usual place of work to the agreed training programme location Number of Trips : Estimated Costs :
Method of Travel : NOTE - if you are DHB Staff then you must use a DHB Staff Vehicle If car please indicate Km's
Actual costs for accommodation required at the agreed training programme location. Maximum of $130 per night Estimated Costs
Clinic Mentoring
Clinical Mentoring access costs (per hour)for clinical assessment paper required during the trainees working hours. 		Number of Hours : Estimated Costs - No more than $28/hour:
       
Section I.
Sign Off
This form must be completed electronically submitted with the appropriate supporting documentation to the HWNZ Funding Coordinator - Liz Buckley. A confirmation of receipt will be sent to the applicant via email.

We only accept the following files for uploading .pdf, .doc, .docx, .xls, .xlsx
You can only upload one file at a time. Please Upload File 1 and then Upload your File 2.
Upload File 1:             
Upload File 2:             
Upload File 3:             
Section J
Declaration
I confirm that all the information supplied in support of my application is accurate at the date of signing and the supporting documentation is enclosed.

I declare that my Manager supports this application.

I consent to the disclosure of the personal information given on this form to recipients for purposes related to the advancement of my studies and as required by protocols between BOPDHB and external Agencies.

I authorise and direct any Tertiary Education provider at which I am/have been undertaking any course of study relating to this grant to provide to Bay of Plenty District Health Board and Health Workforce New Zealand the following information:
  • Full Name
  • Relevant course completion information
  • Date of course competion
  • Outcome of Course
  • Pass or Failure to attain a pass
  • Withdrawal for course
  • Date and reason for withdrawl
Section K
This form must be sent electronically to liz.buckley@bopdhb.govt.nz. Supporting documentation must be scanned and uploaded or posted to the HWNZ Funding Coordinator - Liz Buckley, 4th Floor, Tauranga Hospital
or
Liz Buckley,
HWNZ Funding Coordinator,
Bay of Plenty District Health Board,
Tauranga Hospital,
Private Bag 12024, Tauranga 3112
1 Uploaded your Career Plan above :
2 In submitting this form electronically I agree to the declarations in Section J:
Thank You