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Application Form - Applicant

The Albert Coates Memorial Trust
Rural Nursing Scholarships - 2027 Gippsland Dept. of Health Region

Instructions for the applicant and health service supervisor:

  • This application form is in two parts. The first part is completed by the applicant. At the end of Part One there is a space for the name and email address of the applicant’s supervisor at your health service.
  • Digital copies of the applicant's resume and any other documents should be uploaded as indicated on the form.
  • Once Part One is completed you should click on the ‘Forward to Supervisor’ button.

Part Two of the application should completed by the workplace supervisor who has agreed to support your application. The supervisor should have authority to approve your participation in your selected studies.

Section 1 - Applicant Details

To be completed by the applicant.

Are you an Australian citizen or permanent resident?
Do you have a relative or descendant who is an ex-service man/woman?

If yes, please upload documents giving evidence supporting the defence force relationship.

Section 2 - Sponsoring Health Service Details

Section 3 - Details of Course Study

Have you received confirmation that you have been accepted into the above course?

If 'no, you will need to supply evidence of acceptance into the course to the Coates Trust, prior to your health service receiving funds.

Will the course allow you to practise in emergency/urgent care in rural areas once you have finished the course?

Statement of commitment by applicant:

I agree to:

  • utilise scholarship funds only for the purpose of completing the identified course, and
  • notify the sponsoring health service and the Albert Coates Memorial Trust if I withdraw or am excluded from my course and return uncommitted/unexpended funds, and
  • complete written reports and give a presentation to the Trust as described in the above guidelines.
Please ensure you upload the required supporting documents with your application:
Select File

Submit and forward to your supervisor

By submitting the above application a copy will be sent to the Albert Coates selection committee and also your supervisor listed below. They will be required to fill in part 2 of this application. Please make them aware that this will be coming through.