TRCHR Education Fund Graduate / Fellowship Application Form. Application Deadline: July 15, 2015, 5:00 pm. Funding Start Date: September 1, 2015

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1 TRCHR Education Fund 2015 Graduate / Fellowship Application Form Application Deadline: July 15, 2015, 5:00 pm Funding Start Date: September 1, 2015 Awards The TRCHR graduate (MSc/MPH/MBA) award is a one year $18,000 award to support full-time students completing a Master s program (MSc/MPH/MBA) The TRCHR graduate-phd award is a $48,000 award ($24,000/year renewable) to support full-time graduate students completing a PhD program The TRCHR fellowship award is an $80,000 award ($40,000/year renewable, 2 years max) to support full-time post-doctoral fellows, who are within 5 years of PhD completion. More information regarding the TRCHR is available here. Eligibility The trainee must be supervised by a Faculty member or Senior Scientist of a TRCHR Partner Institute: SickKids, UHN, UofT (including any other UofT affiliated teaching hospitals) Evaluation Criteria Academic excellence of the candidate Significance and quality of the project and its alignment with the Mission and objectives of the TRCHR Evidence of collaboration among 2 or more of the 3 TRCHR partner institutions (SickKids, UHN, UofT) Supervisor s research and training accomplishments (ie publications, grants, number of trainees supervised, commercialization of findings) Application Checklist Please ensure your completed application includes: Completed application form Current Curriculum Vitae and publication list Applicant s academic transcript (1 copy) Supervisor's Common CV

2 Applicant Information Name Citizenship Mailing Address Sex Female Male City Province Postal Code Institution Academic Program Degree Name Start Date of Academic Program (DD/MM/YYYY) Faculty/Program Address Level of Study MSc/MPH/MBA PhD Post-doctoral fellowship Estimated End Date of Academic Program (DD/MM/YYYY) Student Number Have you applied for stipend/salary support from other agencies? No Yes If Yes, please provide the following information: 1. Program Name Awarded Pending No Yes No Yes Date of Support (MM/YYYY MM/YYYY) Amount 2. Program Name Awarded No Yes Pending No Yes Date of Support (MM/YYYY MM/YYYY) Amount Supervisor Information TRCHR Affiliation SickKids UHN UofT Other UofT affiliated site Name Position Department Institution Office Address City Province Postal Code Telephone no. Address TRCHR Scientific Lead affiliation v2.1 1

3 Applicant Academic Record Degrees and Certifications (include those expected in the next 12 months) Degree/Diploma Discipline Institution Dates (MM/YYYY) From To Relevant Research Experience Position Institution/Company Supervisor Dates (MM/YYYY) From To Publications: Provide full references for your top 3 published papers/abstracts. Also attach a publication list of complete references for i) papers and ii) abstracts published or in press Publication List Attached No Yes v2.1 2

4 Proposed Research Project Project Title Proposed Start Date Proposed Supervising PI Name TRCHR Program Affiliation SickKids UHN UofT TRCHR Collaborating Partners Project Description Background & Rationale Objectives and Research Plan v2.1 3

5 Objectives and Research Plan (Cont d) v2.1 4

6 Objectives and Research Plan (Cont d) Describe how your project supports collaboration among the TRCHR partner organizations Describe how your project fits with the objectives of the TRCHR v2.1 5

7 Describe how your project will further your career goals Applicant Signature Block I certify to the best of my knowledge all information in this application for a (select one) MSc/MPH/MBA award PhD award Post-doctoral fellowship award is accurate. Print Name: Signature Date (DD/MM/YYYY) Supervising PI Signature Block I support this application to the TRCHR Education Award Program and will supervise this candidate in my lab/clinic/area for the duration of this graduate/doctoral/post-doctoral fellowship award. Print Name: Signature Date (DD/MM/YYYY) Please ensure the following documents are attached with your application: 1. Reference List (1 pg maximum); 2. Curriculum Vitae and publication list; 3. Academic Transcript (only graduate program transcripts are required); 4. Supervisor's Common CV v2.1 6

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