Reach Beyond Bursary Application Form

OLD VERSION Reach Beyond Bursary Application Form (used until 2022)

Please ensure you have read and understand all the information about this bursary before applying including the requirements of successful bursary candidates. Applicants are reminded this bursary is for individuals from countries with low-middle income economies. We recommend filling this form when you are able to complete it in full as unfortunately you will not be able to save and return later. You may like to write the supporting statement in a document and copy it over when you are ready. If you have any questions please email 'kim@brazelton.co.uk' before submitting your form.

Title
Full Name*
Address*
Country*
Email Address*
We will use this email address to contact you if you are successful. Please ensure you have entered it correctly or we will be unable to get hold of you.
Phone number
Job Title*
Employer*
Employer's Address
Is your Employer/Manager aware that you have made this application?
- Yes
- No
Your Manager's Name (if appropriate):
Your Manager's Email (if appropriate):
I am applying for a bursary for:*
- The Newborn Behavioural Observations (NBO) certification course
- The Neonatal Behavioural Assessment Scale (NBAS) certification course
I commit to training and certifying in this course. And I commit to fufilling the other requirements of this bursary award. Tick to agree below*
Individuals and pairs successfully awarded the bursary are expected to fulfil the following: 1) Book onto a course between 1st January and 31st December 2023 BY 31st December 2022 2) Certify within 6 months of attending the NBO training course and within 12 months of attending the NBAS training course. 3) Send back written reports (approximately half an A4 document is sufficient) of impact to kim@brazelton.co.uk at 3 months, 6 months and 1 year following certification including details on how you are implementing the NBO/NBAS into your work with families and the impact you are seeing. Reports will preferably include at least one photo and one piece of feedback from a parent and/or manager, for which you have gained consent for the Brazelton Centre UK to use on their website and social media.
- I agree
Please use the space below to write your supporting statement which will be used to select bursary winners*
Please cover the following points in your statement: Please tell us why you require the Reach Beyond bursary to support your training place? Why do you wish to receive NBO/NBAS training? How many families will benefit from your training and in which locations? How will you implement and embed the NBO/NBAS into your work/your programmes to promote the voice of the baby? How will the NBO/NBAS improve your work with families? What impact and results do you anticipate to see?
Declaration and acknowledgement: I declare that the information I have given is correct, to the best of my knowledge. I acknowledge that the funds will be used to pay The Brazelton Centre UK CIO to provide one free training place and that there is no additional monetary award available. I understand this bursary award is non-transferable beyond 2023 and is conditional upon the successful completion and certification of the NBO/NBAS course and that the full course fee must be repaid to the Brazelton Centre UK if I do not certify. I understand that if I am selected as a bursary winner that I must book onto a 2023 course by no later than 31st December 2022.*
Please type your full name to state your agreement with the declaration above.
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Phone
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