ESR Epidemiological Skills Development Programme APPLICATION FORM A separate application will be required for each course Tick Course title Course dates, ESR funded Applications start day 1/end last travel / day accom. 1.3 Outbreak Investigation 10 October 2016 No 19 September Refresher (Gisborne) 10:00 13:00 2016 – 1.2 Effective Case Investigation 26-27 October 2016 No 28 September (Rotorua) 10:00 15:30 2016 – 2.3 Laboratory Investigation 24-25 May 2017 Yes 12 April 2017 (Wellington) 09:45 15:10 – Further course information is available here All courses are free of charge. Some courses include travel and accommodation however places are limited. All course materials and tools will be provided, unless stated. (circle one) Mr, Ms, Mrs, Miss, Other [ ] Sex: Male / Female Name: Sponsoring organisation: Position: Do you have their support? Yes No Postal address: Phone: Mobile: Email: Dietary requirements: Additional supporting information: PHU travel and accommodation sponsorship Travel and accommodation is provided for public health unit staff for applicable courses only Please note: Travel funding from ESR will be limited to the cost of flights as at the close’ ‘application date. Applications received after this date will be subsidised to the value of the flights on this day and the respective Public Health Unit accepts to fund any additional costs i.e. the difference between the most cost effective option as at the deadline and the cost of flights as at the date of application. Accommodation and meals will still be fully funded.
ESR Epidemiological Skills Development Programme APPLICATION FORM A separate application will be required for each course Tick Course title Course dates, start day 1/end last day ESR funded travel / accom. Applications 1.3 Outbreak Investigation Refresher (Gisborne) 10 October 2016 10:00 – 13:00 No 19 September 2016 1.2 Effective Case Investigation (Rotorua) 26-27 October 2016 10:00 – 15:30 No 28 September 2016 2.3 Laboratory Investigation (Wellington) 24-25 May 2017 09:45 – 15:10 Yes 12 April 2017 Further course information is available here All courses are free of charge. Some courses include travel and accommodation however places are limited. All course materials and tools will be provided, unless stated. (circle one) Mr, Ms, Mrs, Miss, Other [ ] Sex: Male / Female Name: Sponsoring organisation: Position: Do you have their support? Yes No Postal address: Phone: Mobile: Email: Dietary requirements: Additional supporting information: PHU travel and accommodation sponsorship Travel and accommodation is provided for public health unit staff for applicable courses only Please note: Travel funding from ESR will be limited to the cost of flights as at the ‘application close’ date. Applications received after this date will be subsidised to the value of the flights on this day and the respective Public Health Unit accepts to fund any additional costs i.e. the difference between the most cost effective option as at the deadline and the cost of flights as at the date of application. Accommodation and meals will still be fully funded.
2017-05-Application-form-for-2016-17.docx