ACEM Foundation Global Emergency Care Scholarship

ACEM Foundation Global Emergency Care Scholarship
Form No: FND441
Last Revised: February 2025

Nominations for the scholarship must be received no later than 5pm AEST Monday 28 April 2025

To be eligible for nomination for a scholarship, the nominee must be a doctor or other emergency care health professional from a low or middle-income country (LMIC), as defined by the ACEM policy on Defining Developing Country. For further information, eligibility criteria and terms and conditions, see the FND376 ACEM Foundation Global Emergency Care Scholarship Policy.

If you require assistance to complete this form, please contact: gecnetwork@acem.org.au

Related documents:
- Policy on Defining 'Developing Country' (COR446)
- ACEM Foundation Global Emergency Care Scholarship Policy (FND376)

Nominator
This section is to be completed by the Nominator.
Nominator details
Full name

First NameLast Name
ACEM ID
Email
example@example.com
Postal address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Country
Eligibility criteria
I am:

an ACEM Fellow of good standing with the Collegea FACEM trainee of good standing with the College
I accept responsibility for arranging a suitable program for the nominee (in liaison with the Global Emergency Care Committee)

YesNo
I plan to attend the Annual Scientific Meeting and am willing to act as a personal host for the nominee.

YesNo
Please provide details of your willing proxy to act as a personal host.
Proxy name

First NameLast Name
Proxy email
example@example.com
Describe your developed linkages with the nominee through undertaking global emergency care development activities in the nominee’s country (max 300 words)
Nominee details

These details will be used to notify the nominee to complete their section of this form
Nominee name

First NameLast Name
Nominee email
example@example.com
Selection criteria
Detail the nominee’s capacity to present at the ACEM Annual Scientific Meeting 2025. (Selection Criteria A(i)) (max 300 words)
Detail the nominee’s actual or potential leadership capacity in emergency care within their home country or LMIC country of residence. (Selection Criteria A(ii)) (max 300 words)
Detail the nominee’s engagement in an area of work that will benefit from the opportunities and learning experiences at the ACEM Annual Scientific Meeting. (Selection Criteria A(iii)). (max 300 words)
Detail the scope for you (or other FACEMs/FACEM Trainees) to support the development of emergency care in the nominee’s country. (Selection Criteria B(i)). (max 300 words)
Describe how the nominee’s region is a priority for ACEM. (Selection Criteria B(ii)). (max 300 words)
Describe how the awarding of scholarship to this nominee will significantly contribute to the overall development of emergency care and may benefit broader strategic goals of ACEM and the Global Emergency Care Committee in the particular country or region. (Selection Criteria B(v)). (max 300 words)
Nominator signature and acknowledgement
I agree to be the nominator for this ACEM Foundation Global Emergency Care Scholarship. Should the nominee be awarded a scholarship, I agree to adhere to the conditions of the scholarship as detailed in FND376 ACEM Foundation Global Emergency Care Scholarship Policy. I agree that ACEM may use my application, or extracts from my application, for the purposes of publication College communications and other promotional material.
Signature

Clear
Date

DayMonthYear
Date