Nova Scotia College of Medical Laboratory Technologists
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Professional Development Grant Application

Applicant Information
Name of Applicant *
Please enter your name
NSCMLT License # *
Please enter your NSCMLT/CSMLS #
Current Address *
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City *
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Province *
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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
Email *
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Have You 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 Please Provide Details
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Organization Information
Name of Employer *
Please enter your organization name
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.

Professional Development Event Information
Actual Start Date Or Indicate That The Activity Will Start In The Current Year *
Please tell us the costs you want to cover
Education Provider *
Please enter a valid email address
Describe Program/ Course/ Degree You Are Taking And What Methods Of Learning Are Used.
Please provide a description of your program
Expected Completion Date *
Please enter a completion date
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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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 medical laboratory profession 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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Land Acknowledgement - NSCMLT would like to begin by respectfully acknowleding that the province of Nova Scotia is the ancestral homelands of many diverse populations and acknowledge that we are on the traditional lands, referred to as Mi'kma'ki the ancestral and unceded territory of the Mi'kmaq People who are the founding people of Nova Scotia under the "Treaties of Peace and Friendship". We respect the Peace and Friendship treaties, we acknowledge the harms and mistakes of the past, and we dedicate ourselves to move forward in partnership with Indigenous communities in a spirit of reconciliation and collaboration.  

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

 

Have an inquiry? Please complete the Contact Us Form under Contact tab

Phone: 902-453-9605

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

Fax: 902-454-3535