Doc 16/11383 2016/2017 allied health workplace learning grant program



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DOC 16/11383

2016/2017 ALLIED HEALTH WORKPLACE LEARNING GRANT PROGRAM

Application Form

The Allied Health Workplace Learning Grant Program provides financial support to teams/groups of allied health professionals and/or allied health assistants seeking to further develop their knowledge and skills through workplace learning opportunities that occur during 2017. Eligible teams/groups of allied health professionals and/or allied health assistants are able to apply for one-off grants of up to $4000 to support access to workplace learning opportunities which will enhance their ability to perform in their current role. While undergraduate students on clinical placement may incidentally benefit from proposed workplace learning activities, it is important to note that students are not the target beneficiary of these grants.




SUBMITTING AN APPLICATION

ENQUIRIES

Before submitting your application, please ensure you have:

  • Read the Terms and Conditions of the program.

  • Completed all parts of this application form

  • Obtained all necessary signatures from designated people


To submit the application, email the completed & signed application form to: HETI-Scholarships@health.nsw.gov.au

Applications must be received by COB on Friday 7 October 2016





Late or incomplete applications will not be presented to the Review Committee.


Kate Fletcher

 (02) 9844 6514



Michael Dunne (Mon/Thur/Fri)
 (02) 9844 6599

 HETI-Scholarships@health.nsw.gov.au




TEAM / GROUP DETAILS

Local Health District / Specialty Health Network:



Name/description of allied health team/group:

eg – Allied Health Stroke Team /
Smithvale Physiotherapy Department



Name of 2016/2017 Workplace Learning activity:

eg – Dialectical behaviour therapy training



Did this team/group receive funding in the 2016 Allied Health Workplace Learning
Grant Program?

☐ No

☐ Yes 

(name of 2016 workplace learning activity)




KEY CONTACT PERSON

Name:



Designation:



Work Address:



Work Telephone:



Work Email Address:





ELIGIBILITY CRITERIA

To be eligible to apply for the Program, applications must meet ALL of the following criteria:

  1. The team/group requesting the funding is predominantly (at least 60%) Allied Health Professionals (AHP) and/or Allied Health Assistants (AHA).

  2. All people in the team/group are currently employed by NSW Health. Consideration may be given where an established working relationship between NSW Health and non NSW Health team/group members exists.

  3. The team/group is seeking to develop and/or support Workplace Learning (WPL) opportunities which will occur onsite in the workplace.

  4. The team/group is comprised of three (3) or more people.

  5. The proposed WPL activities for which the funding is sought are completed by the 31 December 2017.

  6. The proposal is supported by the Allied Health Director or equivalent position.


Applications will be deemed ineligible for funding if:

  1. Funding is being sought for external courses / conferences or post-graduate / tertiary qualifications.

  2. Funding is being sought for products which are intended for patient care.
    (eg – patient equipment / clinical equipment / clinical consumables / standardised assessments)

  3. Funding is being sort for IT or audio-visual equipment

  4. Funding is being sort for shadow placements overseas

  5. Funding is being sort for operational activities (eg. Strategic planning forum)




WORKPLACE LEARNING (WPL) ACTIVITY DETAILS

Location where WPL will take place:

eg – Dietetics Dept, Smithvale Hospital



Number of people involved in WPL activity:



Disciplines of people involved in WPL activity:



☐ Allied Health Assistants

☐ Art Therapy

☐ Audiology

☐ Counselling

☐ Dietetics & Nutrition

☐ Diversional Therapy

☐ Exercise Physiology

☐ Genetic Counselling

☐ Music Therapy

☐ Nuclear Medical Tech.

☐ Occupational Therapy

☐ Orthoptics

☐ Orthotics & Prosthetics

☐ Pharmacy

☐ Physiotherapy

☐ Play Therapy

☐ Podiatry

☐ Psychology

☐ Radiation Therapy

☐ Radiography

☐ Sexual Assault

☐ Social Work

☐ Speech Pathology

☐ Welfare










☐ Medicine

☐ Nursing




☐ Other (please specify) 



Approx. % who are either allied health professionals or allied health assistants:



Are all members of this team / group employees of NSW Health?

☐ Yes

☐ No*  % NSW Health Employees

*If ‘No’, please explain the established working relationship between NSW Health and non NSW Health team/group including its influence on patient care / workplace practices:



If WPL activity involves an external presenter/facilitator, is this person aware of and in agreement with this application?

☐ Yes

☐ No

☐ Not applicable

Will WPL activities be completed by 31/12/2017?

☐ Yes

☐ No




SELECTION CRITERIA

  1. Please provide a detailed description of the proposed workplace learning activities (WPL).
    (max. 300 words)



  1. Please provide justification based on evidence of why these workplace learning activities are important for your team and how they will improve clinical / workplace practices or patient care outcomes. (max. 300 words)





  1. Please state three learning objectives for the proposed workplace learning activities.
    Learning objectives should be specific and measureable

i.



ii.



iii.



  1. Please provide an overview of how you would evaluate these workplace learning activities.
    Consider immediate/short term and long term evaluation (if appropriate) (max. 300 words)


  1. Please provide a budget of how the grant funds would be spent.

(Please attach quotations, if available, when submitting your application. Quotations will strengthen your application)

ITEM

ESTIMATED COST



$



$



$



$



$



$

TOTAL COST

$

If total cost exceeds $4000,

please indicate how additional

funds will be accessed






COST CENTRE MANAGER ENDORSEMENT

If successful, grant funds will be transferred into a NSW Health cost centre. For this to occur, an intra-health invoice will need to be raised by the cost centre manager by COB on Friday 25 November 2016, following notification of successful application. Please nominate a cost centre for the funds to be transferred to.

Cost centre number:



Name of cost centre manager:



Email address:



Telephone number:



Signature of cost centre manager:

(Print off and sign)
Sign:

Date: / / 2016




DIRECTOR OF ALLIED HEALTH*/ PHARMACY* / RADIOGRAPHY* / MENTAL HEALTH * ENDORSEMENT (*or equivalent)

The Director of Allied Health / Pharmacy / Radiography / Mental Health (or equivalent) endorses the workplace learning activities proposed in this application.

Name:



Designation:



Email Address:



Signature:

(Print off and sign)

Date: / / 2016



KEY CONTACT PERSON DECLARATION

I, as the key contact person, declare that the information we have provided in this application is, to the best of my knowledge, true and accurate. In signing this application on behalf of the team, I confirm that we:

  1. have sought approval for conducting these workplace learning activities from the line managers of all people listed in this application

  2. have read the 2016/2017 HETI Workplace Learning Grant Program Terms & Conditions

  3. agree to fulfil the requirements set out in the 2016/2017 HETI Workplace Learning Grant Program
    Terms & Conditions

  4. will reimburse the funding back to HETI if we are granted funding and the proposed workplace learning activities are not able to take place.








________________________________________________________________________________________________________

________________________________________________________________________________________________________

________________________________________________________________________________________________________

Name

Signature

Date


Please print off application, obtain required signatures,
then scan and send to HETI-Scholarships@health.nsw.gov.au

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