Educational grant application

Please ensure that you complete ALL sections of the online application form before you submit it.

YOUR DETAILS

Name*

First Middle Last

Date of birth*

Mobile*

Work phone*

Email*

Enter Email Confirm Email

Your home address*

Please click on 'County' to display selection drop-down box.

Street Address Address Line 2 City County Postcode

Number and age of dependent children/adults

EMPLOYMENT

Please ensure that you complete ALL sections of the online application form before you submit it.

Name of current employer*

Address of current employer*

Street Address Address Line 2 City County Postcode

Does your employer support this course?*

*A letter from your manager in support of your application is required. You will be asked to upload the file in PDF or JPG format at the end of the form.

Yes
No

How is your employer supporting your application?*

Are they contributing towards the cost? What is the amount of contribution?*

Please give details*

Current job title*

Current salary grade*

NMC Registration PIN*

NMC Registration renewal date*

THE QUEEN'S NURSING INSTITUTE

Please ensure that you complete ALL sections of the online application form before you submit it.

Are you a Queen's Nurse?*

Yes
No

Have you received educational funding from the QNI in the past?*

Grants from QNI can only be paid once

Yes
No

Year of grant

COURSE

Please ensure that you complete ALL sections of the online application form before you submit it.

Please identify the course/training programme that you wish to undertake:*

How will this course help you to improve the care of your patients OR prepare you for a career in the community?*

(Minimum 150 words, maximum 500 words)

COURSE PROVIDER

Please ensure that you complete ALL sections of the online application form before you submit it.

Course provider*

Course validation*

Course validation: NMC : Education for Health: Open University: Other : please state

NMC
Education for Health
Open University
Other

Please specify

Total cost of course*

* Evidence of cost is required. You will be asked to upload the file at the end of the form. Please note that the QNI grant will be paid to the provider directly.

State amount of funding sought from The QNI*

Have you been offered a place on the course?*

* Evidence is required. You will be asked to upload a letter confirming a place at the end of the form.

When does payment need to be made?*

Payments are made direct to the course provider

Course start date*

Course finish date*

Feedback*

We ask you to complete a feedback form once you have finished the course as a condition of any grant award.

I agree to provide a feedback form to the QNI

Are you receiving a bursary or any funding from elsewhere towards this course?*

Yes
No

What is the name of grant provider and amount of award towards this course?*

Have you applied for your NHS CPD Training grant?

Yes
No

Please give details of award including the amount*

Please give details why not*

NURSING CAREER

Please ensure that you complete ALL sections of the online application form before you submit it.

Please provide a short summary of your nursing career to date*

Employment history/Details of your current role /qualifications professional development activities. (Minimum 150 words, maximum 500 words)

What are your career aspirations? What post would you like to have in 2 years’ time?*

(Minimum 150 words, maximum 500 words)

How did you hear of The Queen’s Nursing Institute?

Signature of applicant*

Date*

Data protection

Your privacy is important to us, and we will NOT pass your details to any third party. The Queen's Nursing Institute will use the information provided on the application form to process the proposal and manage any funding awarded. We will also use the information to communicate with you on issues which we feel may be of interest to you. By providing us with your information, you consent to us using it for the purposes outlined above.

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Educational grant application

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YOUR DETAILS

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COURSE

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NURSING CAREER

Data protection

EDUCATION - Monitoring Form

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