CPD Bursary Application form

Primary Care Learning CIC

Full name

Job Role

PBSGL Group name

Practice/PCN

Email address

Course name

Qualification Title and Level

Training provider

Course start date

Course end date

Total course cost (£)

Weblink to course information

Amount requested

Personal statement

I confirm that:

I am a current member of PBSGL.
I understand that if successful, 50% of the bursary will be paid upon proof of booking, and 50% upon proof of completion.
I agree to repay any funding received if I withdraw from the course without valid reason.
Where the bursary amount requested is less than the course fee, I am self-funding the remainder of the course.

I confirm the above