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* 1. Do you agree to the conditions and requirements outlined by Possums & Co. in relation to being an NDC Rural scholarship recipient?

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* 2. Date of application

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* 3. Title

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* 4. Contact Details

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* 5. Please select the Modified Monash category that applies to you

To be eligible for the NDC Rural Scholarship, you must work within categories MM3 to MM7.

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* 6. Are you of Aboriginal or Torres Strait Islander origin?

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* 7. Please select your health profession(s)

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* 8. Please provide your AHPRA registration number

Or alternative registration e.g., AASW, Speech Pathology Australia

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* 9. Please provide your current place of work

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* 10. 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?

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* 11. Please provide a brief description of the context and nature of your work with parents and babies in the first year of life

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* 12. 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.

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* 13. Can you describe any challenges to provide perinatal care that are specific to your local context?

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* 14. How can participation in NDC Accreditation support you with these challenges?

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* 15. 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)

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* 16. 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)?

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* 17. Is there anything else you would like us to consider as part of your application?

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