CARER GRANT APPLICATION Carer Grant YOUR DETAILSTitle(Required)DrMrMsOtherIf other, please specify Name(Required) First Last Institutional Affiliation(Required)Monash UniversitySwinburne University of TechnologyThe Australian National UniversityThe University of AdelaideThe University of MelbourneOtherIf other, please specify Please select your role in OzGrav(Required)CIStudentPost docAIOtherIf other, please specify Phone Number(Required)Email(Required) Are you a primary carer?(Required)YesNoUSE OF FUNDSAmount applying for (up to $2,000)(Required) Please provide simple budget breakdown of what the funds will cover(Required)SUMMARY OF EVENTName of event/conference you would like to attend(Required) Date/s of event(Required) MM slash DD slash YYYY Location(Required) Benefits to attending this event(Required)Implications if unable to attend event(Required)Please outline your regular carer responsibilities and advise if you have previously had any career disruptions due to being a primary carer(Required)Your application will be received by the Chief Operating Officer, Yeshe Fenner, who will send it to the OzGrav Equity and Diversity Committee to review. If you would prefer that the application reviewed by the Committee is anonymous (i.e. your name, contact details, and institution removed), please tick the box belowPlease keep my identity anonymous
