Bravura LSO education scholarship application form 58F6A24881E84245A7C6DD243028168C First name Last name Preferred phone number Preferred email address Workplace Position title Hours of work as full-time equivalent Is your workplace in a rural, regional or remote area? Yes No To which local associations (LA) do you belong? New South Wales Operating Theatre Association (NSW OTA) Northern Territory Perioperative Nurses Association (NTPNA) ACORN Queensland South Australian Perioperative Nurses Association (SAPNA) ACORN Tasmania Victorian Perioperative Nurses Group (VPNG) ACORN Western Australia How long have you been a member? Have you ever received financial assistance from ACORN? Yes No If yes, when did you receive it, what was it for and how much did you receive? Submit
