Application Form for GERONTOLOGY ACCELERATION PROGRAMME (GAP), 2019-2020
ENTRY TO THE GAP PROGRAMME WITH POSTGRADUATE NURSING STUDIES COMMENCING IN SEMESTER 2, 2018

ADMINISTERED BY THE CANTERBURY DISTRICT HEALTH BOARD

This form will cover application for the Gerontology Acceleration Programme (GAP) which includes HWNZ Funding for postgraduate study. Funding is available for payment of University fees and study leave for attendance at compulsory study blocks. It is administered by the Postgraduate Nursing Education office at the Canterbury District Health Board - funding is not paid directly to the trainee.

Please ensure your application meets the GAP eligibility of 0.8 to 1.0 FTE with more than 12 months experience in nursing older adults. Please ensure your application also meets funding eligibility as set out in the Health Workforce NZ website:
http://www.health.govt.nz/system/files/documents/pages/1-b57-hwnz-postgraduate-nursing-training-spec.doc

This is a GAP and HWNZ funding application only - it is NOT an enrolment to university. You will need to enrol with the University separately.

Title
First Name *
As recorded on Nursing Council Register
Your answer
Preferred First Name (if different to above)
Your answer
Last Name *
As recorded on Nursing Council Register
Your answer
Preferred Last Name (if different to above)
Your answer
Nursing Council Registration Number *
This must be 6 digits
Your answer
Date of Birth *
dd/mm/yyyy
Your answer
Male/Female *
Which tertiary institution do you intend to study at? *
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