ACEM Foundation Conference Scholarship

ACEM Foundation Conference Scholarship
Form No: AP419
Last Revised: March 2025

This scholarship is open to ACEM trainees, medical practitioners, medical students or other health professionals who are Aboriginal and/or Torres Strait Islander or Māori who are actual or potential leaders in the development of emergency medicine.

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

Applications may be made during the time that is detailed on the ACEM Website and ACEM Bulletin.

Applications will be reviewed by the Indigenous Health Committee and the ACEM Foundation Committee.

Awardees will be notified by email.

Related Documents:
- ACEM Foundation Conference Scholarship Policy (FND418)
- Applicant name
  
  First NameLast Name
- Email
  example@example.com
- Phone
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Supporter details
  
  These details will be used to notify your supporter to complete their section of this form
- Supporter name*
  
  First NameLast Name
- Supporter email*
  example@example.com
- Eligibility
- I am:
  
  AboriginalTorres Strait IslanderMāori
- Occupation
  
  ACEM TraineeMedical PractitionerMedical StudentOther health professional (please specify)
- Place of employment/study
- Professional qualifications
- Recognised Indigenous organisations of which you are a member:
  
  Australian Indigenous Doctors’ Association (AIDA)Te Ohu Rata o Aotearoa (Te ORA)Other (please specify)
- Have you previously received the ACEM Foundation Conference Scholarship?
  
  YesNo
- Conference
- Detail your current engagement in an area of work or study that will benefit from the opportunities and learning experiences to be gained at ACEM Annual Scientific Meeting (ASM) or the ACEM Winter Symposium.
- Signature and acknowledgement
- Should I be awarded a conference scholarship, I undertake to submit a brief written report on the conference and key learnings within four (4) weeks of the end of the conference and also agree that ACEM and the ACEM Foundation may use my report, or extracts from my report, for the purposes of publication in ACEM Foundation communications and other promotional material.
- Signature
  
  Clear
- Date
  
  DayMonthYear
  Date
- Supporter name
  
  First NameLast Name
- Email
  example@example.com
- Phone
- Place of employment/study
- Professional qualifications
- I am:
  
  Doctor active in emergency medicine careNurse active in emergency medicine careSocial worker active in emergency medicine careIndigenous liaison worker active in emergency medicine careACEM Fellow of good standing with the CollegeACEM trainee of good standing with the CollegeAn Indigenous graduate member of the Australian Indigenous Doctors’ Association (AIDA)An Indigenous graduate member of Te Ohu Rata o Aotearoa (Te ORA)
- I plan to attend the ACEM conference applied for and can host the applicant.
  
  YesNo
- Detail the applicant’s demonstrated interest in emergency medicine practice and/or research.
- Detail the applicant’s demonstrated leadership qualities in their field of endeavour.
- Applicants are required to submit a letter of support as part of their application.
- Attach letter of support
  
  Cancelof
- Signature and acknowledgement
- I agree that the above information is a true and accurate record and I confirm my support of the applicant to attend an ACEM Conference.
- Signature
  
  Clear
- Date
  
  DayMonthYear
  Date
- Should be Empty:

ACEM Foundation Conference Scholarship

Supporter details

Eligibility

Conference

Signature and acknowledgement

Signature and acknowledgement