Application Form for Graduate Studies at IRIC

Application form for graduate studies at IRIC

IDENTIFICATION AND CONTACT INFORMATION

First name / Last name / Gender / Date of birth (YYYY-MM-DD)
M F
Country of birth / Status in Canada
Canadian citizen / Permanent resident / International student
Mailing address
Email / Phone (999-999-9999) / Skype Account / Language skills / Reading skills
Fr Eng / Fr Eng

CHOICE OF STUDY PROGRAM

I would like to join IRIC to pursue graduate studies at the:

M.Sc. level
Ph.D. level

In the following program from Université de Montréal:

Systems Biology
Other program, please specify:
I would like to start my training at IRIC:
Semester: Summer (May) Fall (September) Winter (January)
Year:

RESEARCH INTERESTS

Check off the boxes corresponding to your research interests:

Antigen presentation
Autoimmune diseases
Biochemistry
Bio-imaging
Bioinformatics
Bone marrow transplant
Breast cancer
Cell biology
Cell differentiation
Cell division
Cell migration
Cell proliferation
Chemotherapy
Chromatin / Chromosomes
DNA damage
DNA microarrays
Drug discovery
Flow cytometry
Genetics
Genomics
Hematopoiesis
High-throughput screening
Histology
Histone acetylation
Immunology
Informatics
Intracellular signaling / Leukemia
Mass spectrometry
Medicinal chemistry
Membrane receptors
Metastases
Model organism - C. albicans
Model organism - C. elegans
Model organism - D. melanogaster
Model organism - M. musculus
Model organism - S. cerevisiae
Model organism - X. laevis
Molecular and 3D modeling
Molecular biology
Nuclear receptors / Oncogenes
Pharmacology
Proteomics
Sequencing
Stem cells
Synthetic biology
Systems biology
Telomeres
Transcription factors
Transgenesis
Tumor development
Vesicular transport
Virology
Other (specify) :

ACADEMIC BACKGROUND

Outline your academic background; beginning with the most recent degree that you will have obtained prior to enrollment at IRIC:

Diploma (e.g. B.Sc., M.Sc., Ph.D.) / Name of the program / Field of study
Name of the university / City of the university / Country of the university
Year of enrollment / Year of graduation / Grade point average (GPA) / Maximum GPA possible / Minimum passing GPA
Diploma (e.g. B.Sc., M.Sc., Ph.D.) / Name of the program / Field of study
Name of the university / City of the university / Country of the university
Year of enrollment / Year of graduation / Grade point average (GPA) / Maximum GPA possible / Minimum passing GPA
Diploma (e.g. B.Sc., M.Sc., Ph.D.) / Name of the program / Field of study
Name of the university / City of the university / Country of the university
Year of enrollment / Year of graduation / Grade point average (GPA) / Maximum GPA possible / Minimum passing GPA
Diploma (e.g. B.Sc., M.Sc., Ph.D.) / Name of the program / Field of study
Name of the university / City of the university / Country of the university
Year of enrollment / Year of graduation / Grade point average (GPA) / Maximum GPA possible / Minimum passing GPA

ACADEMIC AWARDS

Academic awards or scholarships that you have received

SCIENTIFIC PUBLICATIONS AND PRESENTATIONS

Contributions to scientific publications (references only)
Oral or poster presentations during scientific meetings (name, location and date of the meeting, title of your presentation)

RESEARCH EXPERIENCE

Indicate any relevant research experience (e.g. internship, summer job in a lab), from the most recent to the oldest:

Name of employer
Name and email address of your supervisor
Position you occupied
Description of your responsibilities
Name of employer
Name and email address of your supervisor
Position you occupied
Description of your responsibilities
Name of employer
Name and email address of your supervisor
Position you occupied
Description of your responsibilities

REFERENCES

Provide details of a minimum of two persons who will act as referees in support of your application (only mandatory for Ph.D. candidates)

First and last name
Employer
Position occupied
Email address
First and last name
Employer
Position occupied
Email address

SOURCES OF INFORMATION

Do you follow IRIC on Facebook?
/ Do you follow IRIC on Twitter?

Yes No / Yes No
How did you hear about IRIC for the first time?
IRIC website
Visit of IRIC
Facebook
Twitter
Advertisement on UdeM campus
Advertisement on another campus
Television / Radio
Newspaper / Magazine
Scientific publication / Family / Friend / Colleague
Teacher (specifiy name) :
IRIC Pizza Slice & Science Lunches
IRIC Next Generation Internship Awards program
Université de Montréal open house
Scientific event (specifiy name) :
Graduate studies fair (specifiy name) :
Other website (specify) :
Other (specify) :

Page 1 of 5