Application form - 2023 Avant Foundation - Australian Indigenous Doctors' Association

06 Dec 2021

Uncategorized

Name*
First Last
Phone*
Date of Birth*
Date Format: MM slash DD slash YYYY
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
State*
Please indicate below whether you identify as:*
- Aboriginal
- Torres Strait Islander
- Both Aboriginal and Torres Strait Islander
Please indicate your AIDA membership status:*
- I am a current AIDA Member
- I have submitted an AIDA Membership Application
I agree to provide short reports/articles/interviews outlining my experience as a first-year medical student at the middle and end of the bursary. I understand that these may be used as part of relevant organisational articles, reporting and social media by AIDA and the Avant Foundation.*
- Yes
I consent to having my photo taken, and consent that these photos can be used in organisational products.*
- Yes
I will notify AIDA and the Avant Foundation of my progression through my degree.*
- Yes
Written Confirmation*
I have attached written confirmation of my offer and enrolment from my training institution.*
- Yes
Which university will you attend in 2023?*
If you are entering a graduate program, please list your undergraduate degree/s and major/s.*
What motivates you to study medicine? (up to 200 words)*
Discuss your commitment to Aboriginal and/or Torres Strait Islander health? (up to 200 words)*
How do you intend to use the Bursary? How will this be of benefit to you? (up to 300 words)*
Other comments (optional – up to 500 words)

There will be no appeals process.

06 Dec 2021

Application form – 2023 Avant Foundation