Apply for the Colleen Sullivan Scholarship

Please complete the application form below, which will appear on this page from 9 July to 17 August 2018.

Important Note: You will not be able to save a partially completed form, so you will need to have all the information ready before applying.

It is also advisable to make sure you have all your information saved to a text or Word document. (That way, if there are any problems in submitting the form, you do not lose the content and can re-enter it.)

Application Form

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  • Personal Details



  •  - 
  • Curriculum Vitae

  • Position 1 Position 2 Position 3 Position 4
    Position
    Employer
    Start Date
    End Date
  • Study/Course 1 Study/Course 2 Study/Course 3 Study/Course 4
    Qualification
    Institution
    Year
  • Award/Prize 1 Award/Prize 2 Award/Prize 3 Award/Prize 4
    Title of Award
    Institution
    Year
  • Scholarship Benefits

  • Reference

  • Filename
    Status
    Size
    • Terms & Conditions

    • I confirm that:

      • I have been a member of AAPM for a minimum of two years
      • I am currently employed in a healthcare practice as a Practice Manager or similar role
    • If I am successful in being granted a scholarship, I undertake to:

      • complete the course of study within two years of announcement of the scholarship
      • provide an article for publication in the AAPM National Journal, The Practice Manager, on a Core Principle topic
      • provide an article for publication in the UNE Partnerships newsletter
      • promote the Colleen Sullivan Scholarship and the Membership Pathway program at a state or national event during the two-year period