UHSussex Educational Bursary Application

Your Details

Title *

First Name *

Last Name *

Job Title *

Dept/Directorate *

Staff Number *

Which Trust do you work within? *

Primary Work Location *

Your Email Address *

Your Contact Telephone Number *

Line Managers Details

Line Managers Name *

Line Managers Contact Telephone Number *

Line Managers Email Address *

Has your Line Manager approved this application? *

Yes

YOU MUST HAVE THE APPROVAL OF YOUR LINE MANAGER BEFORE APPLYING

Outline of Proposal

Title of course or conference *

Have you applied for the conference fees through IRIS? *

Yes

Please confirm that you explored alternative funding sources (i.e. IRIS) and explain why these were not available *

Are you planning to share any expenses with other colleagues who are attending the same event? *

Yes

If YES, please provide further details

(e.g. the total cost, your individual share of the cost and the names of colleague/s you are sharing costs with)

Venue *

Date of the course or conference (NOT TODAY'S DATE) *

If between two dates - put the first date you would like to attend.

How much are requesting for course/conference registration fees? *

How much do you estimate your travel costs to be? *

How much do you estimate your accommodation costs to be? *

How much are you requesting in total from the SHC? (Up to a maximum of £500) *

Please provide further details of your costs *

Please include a breakdown of all your costs and links to where you will purchase any tickets and your proposed travel and accommodation arrangements including the dates of travel and hotel check-in and check-out.

Benefit of attending *

Please give as much information as possible about your request. How will it benefit you and improve cardiac healthcare in Sussex?

Helping the SHC help you

Please help us publicise our work *

Our supporters love to learn how we spend the funds we raise. It helps us immensely if you are able to take photos at your event, write a thank you or make a social media post. What could you do for us?

Would you be happy for us to contact you at a future date to request your help at one of our events? *

Yes

What does the SHC mean to you? *

Declaration

I declare that the information given on this form is true and that any funds received would be solely for the purpose as detailed above.
I have fully completed this application form and enclosed cost estimates.
I agree to make invoices/receipts available on completion of the project on request.
I agree to abide by the conditions set out by the Sussex Heart Charity in making the award.
I agree to return any bursary made if it is no longer possible to proceed with the purpose of the application.
I have read and understood the full terms and conditions.

Check to confirm and submit your application

I AGREE

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Educational/Conference Bursary Application Form UHSussex