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APPLICATION FORM

Schizophrenia Society of Canada Foundation (SSCF) and

Canadian College of Neuropsychopharmacology (CCNP) Studentships

for Biomedical Research in Schizophrenia and Psychosis

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1. PERSONAL DATA

Applicant name:
Complete mailing address:
Telephone: / Email:

2. ACADEMIC BACKGROUND

Degree / University / Country / Field / Dates from/to (mm/yyyy) / GPA or
Average

3. HONOURS, AWARDS, DISTINCTIONS

Agency / Name orDescription / Scope(National/Local/Institution) / Monetary value (if applicable)

4. RESEARCH AND OTHER RELATED EXPERIENCE

Position held / Department/Institution / Dates from/to (mm/yyyy) / Research or Other

5. PROJECT INFORMATION

5.1I am applying for a:☐Master’s Studentship☐PhD Studentship

5.2 Title of the research project (one line only)

5.3 Name of supervisor and University

6. REFEREE(must be someone other than the applicant’s supervisor):

Provide the name, title, academic affiliation, and email address of your referee.

Name and Title / Department, Institution / Email / Relationship to applicant / # months referee has known applicant

7. APPPENDICES: Append the following sections to the bottom of this form (do not send as separate attachments). Please respect the word and page limits. Text exceedingthese limitswill notberead.

7.1. Publications and conference presentations (size maximum: none)

  • Complete list of your (1) refereed articles and book chapters and (2) non-refereed articles and book chapters.
  • Complete list of your oral and poster presentations.

7.2. Other significant contributions pertinent to your research background(optional; size maximum:1/2 page)

  • These could includeattendance at workshops or other specialized training sessions, teaching and training activities, knowledge translation, organization of conferences, reviewing of articles,development of guidelines/documents, volunteer activities, community contributions, other relevant work experience or training received, etc.

7.3. Lay project summary (size maxiumum: 250 words)

  • Provide a non-technical summary of your research project, written in language suitable for a lay audience.
  • Indicate the relevance of the project for understanding the causes of or treatments for schizophrenia and related psychosis.

7.4. Relevance of the project for your training (size maxiumum: 250 words)

  • Describe how this proposal relates to your previous research or training, and how obtaining this studentship and the realization of this project will contribute to your future training and career development.

7.5. Detailed project description (sizemaxiumum: 1 page, single space, 2 cm margins, font size 12 pts

max)

  • Provide the description of your projectincluding the rationale and problem definition, general objectives, specific hypotheses or aims, methodology, expected results, significance of this work, and references. (References may be on an additional page.)
  • Indicate the relevance of the project for understanding the causesof or treatments for schizophrenia and related psychosis.

8. TRANSCRIPTS:

  • Please arrange to have the University submit a PDF file of your official* University transcripts directly to our office, or you may provide a scan of the official* transcripts as a PDF. *An official transcript must be stamped with the official University seal.
  • Transcripts should be sent to:

9. SIGNATURE

I certify that the information submitted on my application form was complete and correct at the time of submission. Further, I understand that misrepresentation of any information or failure to provide necessary documents may result in my ineligibility for funding.
I agree that the information pertaining to my file may be shared with the SSCF-CCNP Studentship Evaluation Committee, who will evaluate applications.Other persons or organizations can have access to information pertaining to an applicant’s file only if the applicant has provided written authorization specifying to whom information can be given and the type of information which can be released.
Signature: / Date:

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