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Masters Degree Scholarship
Application Form
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MASTERS SCHOLARSHIP – THE LEARNING CONTRACT
This form has been developed to facilitate a discussion between an individual applying for support in pursuit of Formal Academic
Study (Masters Scholarship) and their line manager. It is envisaged that both the applicant and the line manager complete the form
together and consider honestly, openly and realistically their joint responses to the questions.
1.
Section One – Applicant background Information
1.1 Surname:
1.2 First Name (s):
1.3 Employee Number:
1.4 E-mail Address:
1.5 Work Address (include Department Name)
1.6 Address for Correspondence
PPS Number: ______________________________________
1.7 Work Tel No.
1.8 Home Tel No.
Extension (if available) ____________________
2.
Section Two – Applicants Current Role Information
2.1 Current Job Title:
2.2. Length of Time in Current Role:
Length of Service with present employer
Years
__________________ Years
months
___________________ months
2.3 Consider the Key Objectives of the Current Role
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*Please supply a copy your previous career history details on Appendix A.
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3.
Section Three – Previous Formal Qualifications
3.1 Please List Previous Qualifications Obtained
Qualification
Key Subject (s)
Awarding Body & Date
Funded Y/N
3.2 Internal Programmes or relevant Continuous Professional Development (CPD) if not listed above.
Qualification
Key Subject (s)
Awarding Body & Date
Funded Y/N
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4.
Section Four – Details of Proposed Course of Study
4.1 Course Title:
4.2 Qualification Obtainable:
4.3 College/Institution:
4.4 Course Duration:
academic year (s)
4.5 No. Weeks/Months Per Year:
Current year of course ____________
4.6 Course Start Date
Please include documentation, which clarifies that this course runs over an academic year
4.7 What are the main objectives of the course?
4.8 List Course Modules
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4.9 Total Course Fees
€
PER YEAR
€
IN TOTAL
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5.
Section Five – Learning Contract
5.1 Please outline your rationale for applying for the Masters Scholarship, in terms of previous work experience,
qualifications and relevance to your career plans
5.2 Has any relevant needs analysis or discussion with your manager taken place in advance of submitting the application
to ensure the applicant is fully equipped and prepared for this undertaking?
5.3 What contribution will the course make in assisting you in the objectives of your present role?
5.4 What is expected to be gained personally (by the applicant) from this course?
5.5 How will the learning relate to current & future management practice?
5.6 Is there an opportunity to pass on elements of future learning from the programme to the applicants’ team or
colleagues?
5.7 What areas of local/national (health related) interest could be undertaken as a potential research topic?
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6.
Section Six – Agreement on Recommended Support
We (the line manager and applicant) agree and propose the following.
We understand that the details below are proposed only and must be approved centrally.
6.1 Amount of Fees to be Paid in Year One:
N/A
6.2 Agreed Study Leave
Number of Days (Year One)
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Estimated Date to be taken (Month)
6.3 Agreed Exam Leave
per exam
Note, if two or more exams fall on the same day, only one exam leave day will be allocated
6.4 Agreed time off to attend course/seminars (Please complete and tick one box only)
Number of Days/Hours
Every (e.g. week, month)
The individual will be rostered so that they are not working these times (although will still work a full week)
The individual will be given the time off to attend this course
6.5 We agree to meet every
shared and discuss support required.
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week to discuss progress, explore how learning can be further
6.6 We agree to discuss the relevance of the subject matter proposed for research purposes in terms of organisational
priorities. Thesis subject matter in particular will need to be signed off by the Assistant National Director of HR or service
equivalent at Area Level.
Please Note; Exam & Study Leave Guidelines
Applications for study and exam leave should be clarified & agreed with your line manager.
The following criteria apply:
1) Persons pursuing courses at Masters Level may be granted four days study leave in each year of the course.
2) Where examinations fall on a day when the staff member would otherwise be on duty at some stage, examination
leave may be granted for the entire day.
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7.
Section Seven – Agreement on Recommended Support and Learning Contract contd
7.1 Applicants Declaration
I agree with the above & all of the following.
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That all material arising from sponsored academic study will become the property of the HSE. Thesis and other
research material will placed on the Irish Health Repository “Lenus” ” & HSE Change Hub Case Study
Repository.
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I understand that proposed leave entitlements (as outlined above) will be subject to staffing demands at the time.
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If I leave the Health Services either during or within 24 months of completing the course, I must repay 50% of the
fees paid for me in respect of this course at the time of leaving.
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I will furnish results on successful completion of examinations. Failure to do so will result in recoupment of 50%
of fees, directly from salary over the following year
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If I fail to attend the programme, which has been funded in advance, the full cost of the course must be repaid,
directly from salary over the following year
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I agree that recoupment of fees arising from academic study costs can be deducted from monies due to me by the
organisation from whatever source available, including salaries, gratuities etc.
Signed: _____________________________________ Date: ________________________________
7.2 Line Managers Declaration
I have held a discussion with
about this application. I fully support and recommend this
application based on the terms outlined above and have set out my rationale for doing so below.
PLEASE PRINT NAME & Sign
Line Managers Name; _________________________________ Job Title; ___________________________________
Working Address: ____________________________________________________________________________________
Contact Number: ___________________________
Signed:
Date:
Line Manager’s Rationale for Recommendation
(For Office Use Only)
Signed:
Date:
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Appendix A.
Date From
Relevant Work History
Date To
Employer & Grade/Title
Description (max 100 words)
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2015 Scholarship Terms & Conditions
Application must be received on or before Friday 15th May, 2015 at 5pm
Late applications will not be accepted.
Please read the following terms and conditions before completing the application: -
1) It must be established (by way of screening & Possible interview) that the Masters
Scholarship is deemed relevant and beneficial to both the individual and the HSE.
2) The course of study will be part-time and is delivered by a recognised and established
body/institution. E.G. Trinity College / RCSI / IPA etc.,
3) The course will lead to the attainment of a Masters Degree in Health
Management/Leadership
4) All applicants must be recommended by local managers following completion of learning
contracts.
5) Original results must be submitted following the successful completion of the course
and any subsequent examinations. Failure to submit this information will result in the
process of recoupment of costs from the employee being enacted. See Section 7.1 Part II
6) Please retain a copy of the application form and any correspondence from this office.
7) Incomplete application forms will not be accepted
8) ORIGINAL APPLICATIONS ONLY. Faxed and/or emailed copies will NOT be
accepted.
9) If you have any queries please do not hesitate to contact Performance & Development
Service at 021 4921213 or email performance&[email protected]
Completed Applications should be marked Payment of Fees and
sent no later than 5pm on Friday 15th May, 2015
TO
Performance & Development Service HSE South
Former Administration Building, St. Mary’s Health Campus
Gurranebraher, Cork
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Applicants Role & Managers Role
The Role of the Line Manager
As a line manager it is your responsibility to:
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Ensure a meeting is held between you and the applicant in order to discuss the application
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Prepare for this meeting by working through the form, considering what you would like
to contribute and anticipating reactions
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Offer advice and guidance to the applicant, considering both their best interests and the
interests of the department/team
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Come to an appropriate and realistic decision as to whether or not the application will be
supported.
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If it is not to be supported, the reasons should be clear and specific. Alternative
development actions should be agreed with the individual.
The Role of the Applicant
As an applicant it is your responsibility to:
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Consider if this course of study is in line with your career development and with the
needs of the department/organisation
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Arrange a meeting with your manager to discuss the application for support. In advance
of this meeting you should fill out the form in draft so that you have considered your
responses to some of the questions
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Accept and (if necessary) clarify the feedback and advice that your line manager may
give you in relation to the application
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Should you be successfully chosen you must commit in writing to completing the course
in line with the agreed terms and conditions herein. Therefore you should fully
understand in advance of making the application the level of commitment required and be
prepared to maximise the benefit of this course both for yourself and the
department/organisation. This may involve sharing your learning with others in the team
etc.
The applicant must read the application form in its entirety and complete sections one to
four before completing sections five to seven in association with your line/senior manager
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