Verna O'Coin Memorial Bursary Application form

Verna O'Coin Memorial Bursary

Application Form

* Indicates required field

Name *

First

Last

Address *

Telephone *

Email *

Employer/Occupation *

Name/Location of Primary Employer *

Name/Location of primary employer (include address, telephone number and email address) *

Statement of Objective(s): Briefly describe the reason this professional development/training is necessary/beneficial for this applicant *

Purpose of the professional development/training: What will this education/training accomplish in your agency/practice/community? *

Describe how the professional development will accomplish this purpose: Types of training, what teaching tasks will be undertaken etc... *

How will you share the results of what you learned with others? *

Bursary amount requested: provide description and amount in Canadian dollars (training fee, other) *

Is the problem/topic important to the community you serve? *

No Maybe Probably Definitely/High priority

Will this educational opportunity contribute to solving the problem? *

No Maybe Probably Definitely/High priority

Is the support from employer and colleagues adequate for you to put training into practice? *

No Maybe Probably Definitely/High priority

Will the learning be shared with others? *

No Maybe Probably Definitely/High priority

Please check any that apply *

I would be willing to write something for the newsletter on my project I would be willing to speak about my project at the Annual General Meeting

Applications must be received 30 days prior to the proposed event.