NextGen Medics Application Form

2024

Program Preference

Choose the program block/s which you wish to be considered for. *Dates of programs may vary slightly or change *

19-25 April 202418-25 June 20245-23 August 2024Any of the above program dates

Personal Details

First Name *

Surname *

Email Address *

Mobile Number *

Date of Birth *

Age (at time of application) *

Are you of Aboriginal or Torres Strait Islander origin? *

Citizenship *

Gender: For demographic and accommodation purposes, how do you identify? *

Residential Location *

City / Town *

State *

Postcode *

Country *

Education Details

1. Are you currently enrolled at an (officially recognised) university or tertiary institution studying Medicine, Allied Health, Nursing or another Health-related degree? *

YesNo

4. What program, field or major are you studying? *If you answered 'other' please type your answer in the box below:

What year of your degree are you currently in, in 2024? *

5. How many years of full-time equivalent course load have you successfully completed in your current Medical, Allied Health, Nursing or Health-related program? *

2. What is the name of the university or tertiary institute are you currently studying at? *

3. In what state/territory is your university or tertiary institute located in? *

6. Have you studied a pre-medical or prior university equivalent program before this? *

YesNo

If yes, please detail the university and program name:

Are you currently a registered Health Care Professional? *

YesNo

7. Are you currently on academic probation, or under any university-imposed sanctions? *

YesNo

Other Details

If you chose 'Other', please type your answer here.

2. Are you currently in the process of being charged with or pleading guilty to a criminal offence in an Australian Court of Law, or its equivalent in any location outside of Australia? This includes but is not exclusive to child-protection and/or child-related offences. This does not relate to traffic infringements or drink driving charges. *

YesNo

3. Do you have any specific dietary requirements needing attention? *

YesNo

These can be specified at later application stages.

4. Are you currently up to date with the current Queensland Health vaccinations, in order to participate in practical placement in medical practices, hospitals and other health service locations? *

YesNo

Referee 1

First Name of Referee 1 *

Surname of Referee 1 *

Organisation of Referee 1 *

Position with Organisation of Referee 1 *

Email Address *

Contact Mobile of Referee 1 *

Referee 2

First Name of Referee 2

Surname of Referee 2

Organisation of Referee 2

Position within Organisation of Referee 2

Email Address

Phone Contact of Referee 2

Selection Criteria

The following questions are to be answered in a typed Word or PDF document and uploaded for review. Your submission is to be no more than 300 words and one page in length.

Please address the following areas within your submission:

Your reason for applying and what you are hoping to learn by participating in the program;
What unique contribution you can offer to the program;
Three specialty areas you are interested in exploring throughout your health study; and
Detail any Leadership, Group/Team and Adaptability examples.

Upload a 1-page Word or PDF document in 12 size Arial font which complies with the specifications above. *

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Health Acknowledgement and Agreement

If requested, I can provide evidence upon enrolment to demonstrate up-to-date immunisations against the following immunisations. I understand this evidence may include a childhood immunisation schedule, serology results with current immunity noted and evidence of further immunisations and/or boosters for those areas I was not immune from.

COVID (current as deemed by Government AND university guidelines)
Hepatitis B
Varicella (Chicken Pox)
MMR (Measles, Mumps, Rubella)
Pertussis (Whooping Cough)
Influenza A (annual immunity)
TB (Tuberculosis) - completion of TB Risk Form initially

*

I acknowledge and understand that any or all of the above-mentioned immunisations may be required by our government, Queensland Health, specific medical practice or Heart of Australia, to attend placement or visitation on site and/or to assist or be supervised by a medical, allied health or other health practitioner at any location throughout the NextGen Medics program. *

I agree to obtain any or all the above-mentioned immunisations which are deemed to be required by our government, Queensland Health, specific medical practice or Heart of Australia, to attend placement or visitation on site and/or to assist or be supervised by a medical, allied health or other health practitioner at any location throughout the NextGen Medics program. This will be done at my cost. I will provide evidence as required, a minimum of 4 weeks before the program start date. *

I acknowldege the robust nature of the NextGen Program and understand that participating in this program will require travel and work observations over lengthy, daily periods. If there are any current or past health or other conditions or concerns, which will hinder my ability to particpate fully in the program at all times, including physical exercise, working in semi-confined spaces, travelling long distances or elsewise, these will be raised by me and discussed with the Program Coodinator, at interview stage. *

Attendance Confirmation and Agreement

I can commit to the whole NextGen Medics program and 100% attendance over the block of the specified dates. Please check you are available during all program dates, BEFORE submitting your application, including Graduation Ceremony dates. There is no opportunity for flexible attendance; full attendance is necessary.

*

I understand that I am financially and logistically responsible to ensure I get to the specified and agreed upon meeting point, (e.g. Brisbane) to begin the NextGen Medics program. I understand that this is likely to be a Queensland destination.

*

I acknowledge and understand that I am financially responsible for any cost related to my admittance into hospital or other medical care, should it be needed whilst on the trip. I acknowledge I am capable of paying any excess to a hospital or private facility upfront, at the time of admittance.

*

I acknowledge and agree that should I be accepted into the NextGen Medics program, I am recognised as a NextGen Alumni and Heart of Australia Ambassador. Within this role, I am to uphold the values of the Heart of Australia organisation and positively promote the program during its duration and afterward when promoting the program.

*

I agree I will give back to the program in the 1-3 years following my participation by: mentoring other students; positively promoting the program to other students, educational institutions and community groups; and attending and/or presenting at Heart of Australia events including promotional, education and external industry and university events (with prior notification and negotiation) when required.

*

I agree to continue connection with the regional and rural health practices and practitioners. This may include attending part of a future NextGen Medics block to assist and mentor current program attendees if requested and as negotiated with the Heart of Australia team.

*

I acknowledge that if I am a successful applicant to the NextGen Medics program, I am strongly encouraged and expected to make every effort to attend the Annual Heart of Australia Gala. I understand that the Gala plays a significant part within the collaborations of Heart of Australia and is a place where our sponsors, alumni, health partners and staff can connect and celebrate the contribution we make together, to rural and remote healthcare.

*

I confirm that all information given within this submission is truthful, accurate and not misleading.

*

Required Documentation

If your NextGen Medics application is shortlisted, you will be required to submit clear copies of your current Student ID, current Driver's Licence/Passport, Immunisation Statement History and Medicare card details.

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