Making a difference
Individual Application
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Start your application
Before you get started, please confirm: *
I have read and understood GVMW Fund Purpose and Guidelines for Applicants.
I authorise GVMW Fund to verify details from the institution at which I am enrolled.
In the event that my application is successful I agree to provide a photo to be published on the Australian Communities Foundation website.
Name *
Your email address *
Saving your form
You can save your application and continue later at any point by clicking the 'Save and Continue Later' button below and retrieving your custom URL.
Before you save or submit your application, please make a personal copy of your application. We are not able to recover lost applications.
Contact details
Address *
Suburb/Town *
Postcode *
State *
Select
Phone *
Name of practice (if applicable)
Evidence
Are you an eligible Secondary School Graduate? *
To demonstrate you are an eligible Secondary School Graduate you must provide evidence to show you are a secondary school graduate who recently commenced, or will commence an eligible degree (ie. undergraduate or postgraduate) in the current calendar year.
Evidence must be provided. Please upload your evidence at the end of this form.
Preference
Are you seeking a preference for disadvantage? *
No
Yes
Eligibility
Indicate your eligibility by confirming the below. Evidence must be provided. Please upload your evidence at the end of this form.
I am an Australian citizen (examples of evidence: birth certificate, passport)
I am a permanent resident (evidence of permanent residency must be provided)
I live in Goulburn Valley (examples of evidence: driver’s licence, bill)
I work in an organisation providing primary care services to the people of Goulburn Valley, and regularly involved in the provision of providing primary care services to the people of Goulburn Valley (examples of evidence: letter of support from practice principal, statement of employment, timesheets from the employer)
Do you intend to pursue your career initially in the Goulburn Valley? *
Yes
No
Details of request
How much funding are you requesting? *
Term of scholarship *
1 year
2 years
Describe how the funds will be used. *
0/400
Describe in 200 words or less how the funds will be used.
Course details
Applicants must provide evidence of acceptance into courses at the end of this application.
Course title *
Year commenced *
Institution or course provider name *
Community needs
Describe how your proposed course matches the needs of the community. *
0/400
In 300 words or less, provide evidence or demonstrate how your proposed course matches the needs of the community.
Sell yourself
Why should your application be considered? *
0/400
This is your opportunity to demonstrate your academic achievements, personal commitment to professional development, future aspirations, understanding of and commitment to the Goulburn Valley community, knowledge of general practice and anything else you think might assist your application. You must provide a copy of your academic transcript and any qualifications you hold. Maximum 300 words.
Upload evidence
Please upload relevant evidence below (PDF preferred, image files also accepted below).
PDF upload
PDF only.
PDF only.
PDF only.
PDF only.
PDF only.
PDF only.
PDF only.
PDF only.
Image upload
Image file only.
Image file only.
Image file only.
Image file only.
Any other comments?
Is there anything else you would like us to know?
0/400
I certify that all information provided by me in this application is true and correct.
The Goulburn Valley Medical Workforce Fund is a sub-fund of the Australian Communities Foundation. It is a non-tax-deductible charitable fund and grants are made to organisations and individuals for educational purposes.