Application for Graduate HEATER Fellowship
Section 1 – Applicant InformationSurname / Given Name / Student ID #
Email Address / Gender
Woman Man
Trans* / Date of Birth (dd/mm/yy)
Citizenship Status as of September 1, 2017:
Canadian Citizen / Permanent Resident / International Student
Section 2 – Training Information
Trainee Program for which award is sought:
Master’s PhD / Start Date: / Completion Date:
Applicant’s Graduate Program or Department, Faculty
Supervisor Name / Mentor Name
Supervisor Title and Affiliation / Mentor Title, Department and Company
Supervisor’s Email Address / Mentor Email Address
Supervisor’s Phone Number / Mentor’s Phone Number
Section 3 - Approvals
The undersigned agree to, and accept, the general conditions governing any award made pursuant to the sponsorship of this application, as set out in the NSERC CREATE grants and awards guidelines, located at as well as all the conditions specific to this CREATE program that are listed on the last page of this application.
PRIVACY NOTICE ‐NSERC requires Dr. Young-June Kim, CREATE Leader, to collect certain personal information from trainees, team members (co‐applicants and collaborators) and other individuals participating in the CREATE program. The purpose of gathering this information is to generate statistics that enables NSERC to report on the CREATE program’s overall performance. Only information that is needed will be requested of the applicants/supervisors. The personal information that is collected, used and disclosed is in accordance with the federal Privacy Act will be shared with the CREATE program committee. The personal information may also be shared with contractors hired to conduct data analysis, surveys or interviews on NSERC’s behalf.
______
Applicant’s Signature / Date
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Supervisor’s Signature / Date
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Mentor’s Signature / Date
Section 4 – Academic History
List ALL postsecondary institutions you have attended whether or not you received a degree from those institutions. In addition include your transcripts (a copy is fine if signed by your supervisor)
Degrees Completed
(or to be completed) / Institution / Started (mm/yy) / Awarded/Expected
Section 5 – Employment History
List all relevant previous employers regardless of whether the position was paid or not.
Position / Institution/Company / Started (mm/yy) / Awarded/Expected
Section 6 –Scholarships, Awards and Bursaries
List all Scholarships, Awards, Fellowships and/or other financial support you have received or applied for. Indicate if the award has not yet been offered.
Name / Agency / Type / Start Date / Duration / Value
S A B / $
S A B / $
S A B / $
S A B / $
Section 7 – Publications
List any previous publications in which you are a co-author. Please include D.O.I.
Section 8 – Project Description – To be completed by the trainee
Below put in the title of your project, and a detailed description of the proposed research project (note: you may include activities that will occur if your fellowship is renewed for an additional 2 years, though you should focus on the first 2 years). Background information should indicate the importance of the research to the field of Thermoelectrics, as well as define scientific/technical terms. State the specific objectives, outline the methodological approach, and provide a timeline for the work. Keep in mind, this is reviewed by a general committee consisting of scientists as well as business leaders with a technical background.
Section 9 – Bibliography list any references used in Section 8
Section 10 – Interaction with the Company (To Be Completed By the Trainee)
In this section briefly describe how you intend to work with the industrial partner. Note you must spend 20% of your time during the fellowship in a “real world” internship. Include the expected start and end date, and whether the internship is continuous (i.e. full-time) or part-time (e.g. one day per week)
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Application for Graduate HEATER Fellowship
Section 12 – Participation in HEATER activitiesHeater fellows are required to take part inEVERY training area, however only SOME of the activities are required (the total in each area is listed). Please place a check mark next to each activity indicating your commitment to that activity upon receipt of a fellowship.
Area 1 – Training Courses
Four HEATER Career Development Workshops. Examples of past workshops are available on the HEATER website.
OR
Equivalent training at your home institution in the following areas: career development, professional skills, communications skills, project management, and entrepreneurship. Each course or workshop needs to be approved by the program director to meet the equivalency requirement. Links to relevant skills workshops are available through the HEATER website.
Area 2 - School and Seminar Series (*Note all activities required*)
Attendance of and presentation of results at the HEATER school
Attendance of the HEATER seminar series
(note: non U of T students may attend video link)
Participation in the organizing committee of: HEATER school OR Seminar Series
(*note students must participate in organizing either the school OR the Seminars*)
Area 3 - Supervision (*Choose one*)
Supervision of a Summer Undergraduate Student
Supervision of an Undergraduate Student during the school year
Section 13 – Support Sources
Heater Fellowships ($13,000 per year) are to be used to “buy-out” students from Teaching Assistants so that they can focus on gaining professional skills needed for their careers. Thus the fellowship must be matched by institutional or other grants to fully cover salary and tuition. Below please indicate the source of these funds and the agreement of the supervisor to ensure the HEATER fellow receives a minimum salary of $23000 in the first year (to be increased by $500 by CREATE funds in the second year).
Funding Source / Amount / Type of Support
$
$
$
$
$
Section 14 - Conflict of Interest Disclosure Agreement
According to guidelines set out by NSERC, a researcher's own consulting company or sole proprietorship is not eligible to collaborate on a project in which the researcher is the applicant or a co-investigator. The company is considered eligible if the company is under the effective day-to-day management control of someone other than the university researcher. This precludes the applicant from holding any internal or external position (e.g., manager, executive, board member) that could influence any decision by the company concerning the management of the project.
The university must be prepared to ensure that the academic interests of students and postdoctoral fellows are protected.
The undersigned agree to disclose the nature of any pre-existing relationship between themselves and the company at which the trainee is completing their internship.
Relationship With The Company
In the space below, please briefly describe the pre-existing relationship between the undersigned and the company at which the trainee will complete their internship.
Applicant’s Signature / Date
Supervisor’s Signature / Date
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