To receive funds, MOAs need to be a part of the Victoria MOA Network and work in a physician-owned/operated clinic. If you are not already a member please apply here.

As a reminder, funds can be used for:
  • Covering the cost of paid-for MOA training/education (e.g., courses, seminars, webinars), OR covering the cost time spent reviewing or completing free offerings/resources (per individual activity)
  • Group facilitation fees (i.e., funds can be pooled across multiple MOAs at a clinic)
** Compensation can be requested for multiple activities, up to $500/MOA.

Funds can not be used for:
  • Compensating both training fees and MOA time (for the same activity)
  • Meeting expenses (e.g., meeting space or food)
  • Travel
  • Purchase of prizes, gifts or alcohol
Please note that funds can be requested retroactively for activities completed between April 1, 2023 and now (please specify in your application)
Clinic information

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* 1. Clinic name:

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* 2. Family Physician name:

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* 3. Name(s) of MOA(s) accessing funds:

Activity details
Please note that funds may be used to cover MOA time OR course/training fees for a single activity – you must select one reimbursement type for each activity.
ACTIVITY 1

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* 4. Please describe the activity:

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* 5. Link to administering organizing/website, if available:

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* 6. Type of reimbursement required (check one)

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* 7. What is the total cost or time required to complete? (Please specify dollars or hours)

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* 8. Who will reimbursements be made to?

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* 9. Please include any additional activity details you'd like to share.

If you plan to complete a second activity, please describe it below:
ACTIVITY 2

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* 10. Please describe the activity:

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* 11. Link to administering organizing/website, if available:

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* 12. Type of reimbursement required (check one)

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* 13. Fees/time spent - please list course fee/total anticipated MOA time (per MOA)

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* 14. Who will reimbursements be made to?

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* 15. Please include any additional activity details you'd like to share.

Who is submitting this application

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* 16. Full name

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* 17. Contact email

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* 18. Clinic role (check one)

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* 19. If application is being submitted by an MOA/Office Manager, please confirm that the clinic physician has approved of the submission.

Thank you for completing the application. A Division staff will be in touch to approve your submission soon.

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