Education and Research Fellowship Fund Application Form

A bursary of up to £2000 to spend on education

Personal Details
Name*
Prefix First Last
Address*
Street Address Address Line 2 City County Post Code Country
Phone*
Email*
Enter Email Confirm Email
Professional Information
Current job title and grade:*
Place of work*
Details of Research
Name of course/study day/conference/title of research*
Course date(s):*

Day
Month
Year
Details of Bursary
Course fee (max one year)*
Other expenses
Total bursary requested*
Are you a member of AfPP?*
- Yes
- No
AfPP Membership Number
Are you a full-time student?*
- Yes
- No
How much financial assistance was requested from your place of work?
Requested financial assistance evidence
Accepted file types: jpg, gif, png, pdf, Max. file size: 5 MB.
How much financial assistance was granted from your place of work?
Granted financial assistance evidence
Accepted file types: jpg, gif, png, pdf, Max. file size: 5 MB.
How much study leave has been granted from your place of work?*
Have you applied for funding from elsewhere? Please provide further details*
Further Information
1. PATIENT: Please explain how the course/research will benefit the perioperative patient care in your workplace?*
2. SELF: How will this course/research enable you to improve your working practice?*
3. ENVIRONMENT: How do you intend the course/research to support the organisational culture of your department?*
4. DISSEMINATION: How do you intend to share the knowledge gained with your work colleagues and peers?*
You are required to enclose a 500 word (max) supporting statement demonstrating how funding would benefit you and the perioperative environment you work in. (Please expand on points 2 and 3 above).*
Please provide supporting evidence for the course/event/research
Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 5 MB.
Full details of: costs (i.e. University quote or a copy of a college prospectus quoting module fees/dates), the course to be undertaken (including dates), breakdown of research proposals/costings (research applications only).
Confirmation*
I agree to abide by the criteria and terms and conditions for general applications to AfPP and confirm that the information I have provided is true and complete.

If you have any queries, please email awards@afpp.org.uk.

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Education and Research Fellowship Fund Application Form

Personal Details

Professional Information

Details of Research

Details of Bursary

Further Information