Charitable Trust of the Auckland Faculty RNZCGP

Application form for research, travel or training grant

Contact information
Name *
Name
Mobile Phone
Mobile Phone
Work Phone
Work Phone
Fax
Fax
Ethnicity
Section 1
Background
If different to above address
Name of host institution (if any) administering any award made e.g. University
Type of award applied for *
Commencement date
Commencement date
Probable commencement date if successful
$
Section 2
Details of application
Names, position and institution of any co-investigators or supervisors. Please indicate whether co-investigator or supervisor
Present project under the following headings: 1. Background 2. Aim/objectives 3. Methodology 4. Relevance & importance to NZ general practice 5. Budget of project 6. Justification of budget 7. Dissemination of research results 8. Timetable 9. References
Present travel application under the following headings: 1. Objectives 2. Itinerary 3. Significance of trip 4. Communication of learning to other GPs 5. Budget
Present training applications under the following headings: 1. Objectives 2. Description of training 3. Dissemination of training to other GPs 4. Costs
Section 3
other information
Do you have other financial support? *
Details of source and nature of other support
Names and contact details of two referees
Ethical approval *
Section 4
Biographical details
List qualifications, year obtained and institution
List in chronological order, earliest date first
Section 5
Administrative agreement
I understand that any grant received as a result of this application will not be expended for any purpose than that described in the application *
A report will be supplied at the end of the project or at any time requested by the Charitable Trust of the Auckland Faculty of the RNZCGP