NDC Rural Scholarship Application Question Title * 1. Do you agree to the conditions and requirements outlined by Possums & Co. in relation to being an NDC Rural scholarship recipient? Yes No Question Title * 2. Date of application Date / Time Date Question Title * 3. Intake rounds for the remainder of the program will be held every 3 months. Closing dates for each round are listed below; please select the intake round you would most like to be considered for (Note: we will accept approx. 40 applicants per round until all 300 scholarships have been offered. We can not guarantee that you will be offered the scholarship in your preferred round, if accepted). Round 4 - 9 September 2022 Round 5 - 9 December 2022 Round 6 - 10 March 2023 Round 7 - 31 July 2023 Other (please specify) Question Title * 4. Title Dr Ms Mr Mx Other (please specify) Question Title * 5. Contact Details Name * Address * Address 2 City/Town * State * Postal Code * Country * Email Address (one that you monitor frequently, preferably one that does not have strict firewalls, e.g., government emails can bounce back) * Phone Number * Question Title * 6. Please select the Modified Monash category that applies to youTo be eligible for the NDC Rural Scholarship, you must work within categories MM3 to MM7. MM3 MM4 MM5 MM6 MM7 Other (please specify) Question Title * 7. Are you of Aboriginal or Torres Strait Islander origin? Yes, Aboriginal Yes, Torres Strait Islander Yes, Aboriginal and Torres Strait Islander No Rather not say Question Title * 8. Please select your health profession(s) Child and Family Health Nurse General Practitioner International Board Certified Lactation Consultant Midwife Obstetrician Occupational Therapist Paediatrician Perinatal Mental Health Nurse Psychologist Registered Nurse Social Worker Speech Pathologist Other (please specify) Question Title * 9. Please provide your AHPRA registration numberOr alternative registration e.g., AASW, Speech Pathology Australia Question Title * 10. Please provide your current place of work Question Title * 11. Can you estimate the proportion of your workload that is usually dedicated to providing care to parents and their babies in the first year of life? 0 100 Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 12. Please provide a brief description of the context and nature of your work with parents and babies in the first year of life Question Title * 13. Can you confirm that you have the capacity to provide ten of your patients with a Possums Parent Hub voucher within the 6-month time frame of the program?A requirement of the NDC Rural Program is that each scholarship holder provide ten (10) of their patients (who are mothers with an infant in the first year of life) a code that enables free access to the Possums Parent Hub - a supportive online community of parents, accompanied by access to a wealth of online resources. Yes No Question Title * 14. Can you describe any challenges to provide perinatal care that are specific to your local context? Question Title * 15. How can participation in NDC Accreditation support you with these challenges? Question Title * 16. Can you think of any resources at your disposal that would facilitate your patients' access to Possums Parent Hub? (e.g., via links to community organisations who could provide meeting spaces, reliable internet for access to the Facebook group) Question Title * 17. Do you consent for us to use your de-identified data (i.e., information that does not specifically identify you) collected during your participation in NDC Rural for research analysis and publication (e.g., aggregate results of survey responses)? Yes No Question Title * 18. Is there anything else you would like us to consider as part of your application? Done
