2019 Recent Graduate Bursary Appliction Form

Step 1 of 11

  1. Section 1: Personal & Practice Details

  2. Application details

  3. *
    Please enter your title
  4. *
    Please enter your first name
  5. *
    Please enter your surname
  6. *
    Please enter your membership number
  7. *
    Please enter your graduation year
  8. Practice details

  9. *
    Please enter your practice name
  10. *
    Please enter your address
  11. *
    Please enter your suburb
  12. *
    Please make a selection
  13. *
    Please enter your postcode
  14. *
    Please enter your phone number
  15. *
    Please enter your email address
  1. Section 2: Personal Career and CPD Plan

  2. 1. Describe your professional experience to date.

  3. *
    Please enter details
  1. 2. Describe the practice you work in and the community you serve.

  2. *
    Please enter details
  1. 3. Briefly describe the professional development courses you have undertaken since graduation and how they have influenced you professionally.

  2. *
    Please enter details
  1. 4. What direction would you like to take your career? Where would you like to be in five years.

  2. *
    Please enter details
  1. 5. What are some of your knowledge gaps?.

  2. *
    Please enter details
  1. 6. Which ADAVB courses (cpd.adavb.org) could help bridge those gaps?

  2. *
    Please enter details
  1. 7. Describe the benefits of the bursary to you and your patients.

  2. *
    Please enter details
  1. 8. Why do you think you deserve this bursary?

  2. *
    Please enter details
  1. Section 3: Dental Practice CPD Log

  2. This application requires dental practitioners to submit a copy of their log of CPD undertaken over the past two years (or since graduation, if less). Please attach a copy of your CPD log.

  3. *
    Please attach file
  1. Section 4: Declaration

  2. I declare that:

    1. I have read the eligibility criteria and I am eligible to apply.
    2. To the best of my knowledge the information supplied in this application is accurate and correct.
    3. I am committed to active and ongoing professional development.
  3. *
    Please accept the declaration