Site Visit Grant Application

Rural Health Workforce Support Program

SITE VISIT GRANT

Grants of up to $3,000* are available to eligible primary health care professionals for a site visit to
practices where there is a mutual interest in a placement.

Eligibility Criteria*
1. Be a health professional who is intending to visit a practice where there is a mutual interest in a
placement as a:
o Aboriginal and/or Torres Strait Islander Health Worker/Practitioner; or
o allied health professional; or
o dentist; or
o medical practitioner; or
o nurse/midwife
2. Have not previously received RDN funding for a site visit in the last 3 years.
3. The location to be visited must be classified on DoctorConnect as:
o MMM 4-7, or
o MMM3 locations of Broken Hill, Griffith and Buronga, or
o The practice is an Aboriginal Community Controlled Health Organisation (ACCHO) in any location
4. Application is submitted and approved BEFORE the site visit
5. Primary health care professionals will be able to apply for a new Site Visit Grant, 3 years from previous
grant request submission.

Grant Amount:
• The amount of the grant is determined using the following matrix based on the location and length of
the site visit:

LOCATION Site Visit <1wk Site Visit 1-2wks Site Visit >2wks AMS
MMM 1 Nil Nil Nil $1,000
MMM 2 Nil Nil Nil $1,000
MMM 3 Nil* Nil* $1,000 $1,500
MMM 4 $1,000 $1,500 $2,000 $2,000
MMM 5 $2,000 $2,000 $3,000 $3,000
MMM 6 $3,000 $3,000 $3,000 $3,000
MMM 7 $3,000 $3,000 $3,000 $3,000
* Site visit is available for MMM3 locations of Broken Hill, Griffith, Buronga

What happens after an application is submitted?

1. Your application will be assessed against eligibility criteria
2. RDN will confirm that the Site Visit is going ahead as planned
3. You will be notified of the outcome of your application.
4. If approved, you will be paid on confirmation that site visit occurred.

If successful you will be sent a payment request form to confirm your acceptance of the grant and provide bank
account details for the grant payment to be deposited.

** NSWRDN has the discretion to consider applications outside of criteria to meet community need

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 Site Visit Grant Application

Title (Dr, Ms etc)

Family Name

First Name

Email address

Contact Phone No.

Male
Gender Date of Birth
Female
Australian Citizen Permanent Resident
Residency Status
New Zealand Temporary Resident Other Temporary Resident
Aboriginal Only
Torres Strait Islander Only
Are you Aboriginal or Torres Strait Islander origin?
Both Aboriginal & Torres Strait Islander
No

Profession
Have you received funds from any other source to assist with this site visit e.g. Potential employer?

No Yes: Amount: $…………………From: .……………………………………...…………

Site Visit Intentions

You must submit evidence to show Practice

Site visit - Mutual interest with Practice agreement for site visit. This could be a letter or
agreement copy of email from the practice contact confirming
the visit

Name of Practice

Location (town) of site visit

Contact person at the Practice

Contact person’s phone number

Date(s) of Visit From: To:

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 Site Visit Grant Application

Applicant Declaration and Consent

• I agree for the information provided in this application to be verified and used confidentially by NSW Rural
Doctors Network (RDN) staff to assess my grant eligibility.
• I understand, the decision to approve a grant follows RDN Corporate Governance processes and Delegation
Authorities policy. An Applicant has the right to appeal against any decision made in the processing of a
grant application. The appeals process is located at www.nswrdn.com.au/contactus
• I understand, I am responsible for organising my own travel and accommodation and paying for this.
• RDN will contact the Practice to confirm site visit arrangements and after the site visit to obtain feedback
from the practice contact.
• I understand that if my application is successful, I am required to provide banking details for grant payment.
• I consent to RDN using details provided in this Application Form for the purposes of monitoring, reporting
and evaluation of the grants program.
• I verify that the information contained within this application form and supporting documents is true and
correct at the date of submission.

Applicant Signature: ..……………………………………… Date: …………………..………………

TO SUBMIT, please email to rdngrants@nswrdn.com.au:

• Completed and signed the application form, &

• Evidence of practice agreement to the site visit.
• Official letter from practice, on letterhead, confirming participation in site visit.

NSW Rural Doctors Network Phone: 02 4924 8000

Suite 1, 53 Cleary Street
HAMILTON NSW 2303 Email: rdngrants@nswrdn.com.au

RDN is committed to protecting the privacy of all individuals who provide personal information in accordance with
The Privacy Act 1988 and the Australian Privacy Principles (APP). If you have any questions in relation to the way RDN
collects, uses, secures or discloses personal information you can contact the Privacy Officer at privacy@nswrdn.com.au or by
phone on (02) 4924 8000. Further information can also be found in the NSW Rural Doctors Network Privacy Policy located
on our website www.nswrdn.com.au

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