Nova Scotia College of Medical Laboratory Technologists

Professional Development Grant Application

Applicant Information

Name of Applicant *
Please enter your name
NSCMLT/CSMLS # *
Please enter your NSCMLT/CSMLS #
How long have you been a member of NSCMLT and CSMLS? *
Please tell us how long you have been a member
Current address *
Please enter your address
City *
Please enter your city
Province *
Please select a province
Postal Code (A1A 1A1) *
Please type your postal code in the following format: A1A 1A1.
Phone (123-456-7890) *
Please type your phone number in the following format: 123-456-7890
Alternate Phone (123-456-7890)
Please use the following format: 123-456-7890
Fax (123-456-7890)
Please use the following format: 123-456-7890
Email *
Please enter your email address
Alternate Email
Please enter a valid email address

Organization Information

Name of Employer *
Please enter your organization name
Current address *
Please enter your organization's address
City *
Please enter your organization's city
Province *
Please select a province
Postal Code (A1A 1A1) *
Please type your postal code in the following format: A1A 1A1.
Has the organization received a NSCMLT grant in the last 3 years? *
Please tell us if your organization has received a NSCMLT grant in the last 3 years
If so provide details
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Professional Development Event Information

Describe Program/ Course/ Degree You are taking and what methods of learning are used.
Please provide a description of your program
Completion Date *
Please enter a completion date
What costs are you asking for this grant to cover? *
Please tell us the costs you want to cover
Amount requesting *
Please tell us the amount you are requesting
Have you attached your documentation showing successful completion?
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Have you attached your documentation showing proof of payment?
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Additional Event Information

Describe what your professional goals are and how this professional development will help you achieve your goals.
Please tell us your professional goals
Describe the potential impact on your organization and the laboratory industry that your professional development will have.
Please tell us the potential impact this will have
You must agree to this statement
Date
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Get in Touch

380 Bedford Highway, Suite 202
Halifax, Nova Scotia B3M 2L4

Email: info@nscmlt.org

Phone: 902-453-9605

Toll Free: 888-897-4095 (NS only)

Fax: 902-454-3535