Margaret Allwright Award for Achievement in Nursing Practice

Margaret Allwright Award for Achievement in Nursing Practice
Name*

First NameLast Name
Submission on behalf of yourself or your team/ward/organisation*
Phone*
Format: (00) 0000-0000.
Enrolled Nurse / Registered Nurse / Registered Midwife*
Current Role*
Hospital / Facility / Service*
Email*
Please note that ALL formal communication will occur by email so please ensure this information is correct.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Heading

Scholarship Eligibility

Please answer the following questions about your eligibility for this scholarship.

Individual applications
YesNo
YesNo
Team/Ward/Organisation applications
YesNo

Referee Details

It is your responsibility to forward the Referee Report to each referee and to submit the reports as part of your online application.

Referee 1
Name*

First NameLast Name
Phone*
Format: (00) 0000-0000.
Email*
example@example.com
Position*
Attach the report for referee 1*

Cancelof
Referee 2
Name*

First NameLast Name
Phone*
Format: (00) 0000-0000.
Email*
example@example.com
Position*
Attach the report for referee 2*

Cancelof