Strategic Training in Transdisciplinary Radiation Science for the 21St Century (STARS21)

Strategic Training in Transdisciplinary Radiation Science for the 21st Century (STARS21)

Program Application

CONTENTS OF COMPLETE APPLICATION

A.Application Form

The original application form must be submitted to

B.Enclosures

Official transcripts of the applicant’s academic record (undergraduate and graduate degrees).

Three reference letters submitted directly by the referees to . Additional assessments will not be considered. These should include (if applicable) an assessment from your most recent research supervisor.

C.Submission

Completed applications must be received by Friday July 15, 2016 @ 5:00 PM.

Applications, official transcripts, and reference letters (submitted separately by the referees) must be submitted to

LATE OR INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED

Strategic Training in Transdisciplinary Radiation Science for the 21st Century (STARS21)
APPLICATION FORM
COMPLETE AND FORWARD THIS SHEET WITH YOUR APPLICATION
This page is for STARS21 use only, for the purposes of communication with the applicant. It will not be included in the evaluation of the application.
Name & Title:
Mailing Address(for Correspondence): / Permanent Address (if different than mailing address):

Telephone Numbers

/ Electronic Addresses
Office: / Email:
Laboratory: / Alternate Email:
Home:
Cellular: / Web homepage:
Fax:
Name of Candidate
I Academic/Training Background
a)Academic Background:
Indicate all university degrees or diplomas obtained and those in progress starting with the most recent.
Degree / Subject of Degree / Institution/Country / Start Date
(MM/YYYY) / Date Received or Expected
(MM/YYYY)
b) Training Experience:
Indicate all undergraduate, graduate, postdoctoral or fellowship research training experience, beginning with the most recent training.
Training type / Institution, Department and Country / Supervisor(s) / Start Date (MM/YYYY) / End Date or Expected
(MM/YYYY)
Name of Candidate

Interruption in training (optional)

If there has been any interruption(s) in pursuit of your training in academia, scientific research, etc., please provide a brief explanation in the space below. List the period and reason for interruption (family or health reasons, etc.)
Common examples of an interruption/delay leading to periods of low productivity might be a bereavement period following the death of a loved one, maternity/parental leave or relocation of your research environment.
II Work Experience
Start with the most recent, indicate your current position, where applicable, and other academic and non-academic position(s) since the beginning of your university studies. For your current positions, leave the end date blank.
Position / Organization and Country / Faculty and Department/School: / Start Date (MM/YYYY) / End Date
(MM/YYYY)
Name of Candidate

III Credentials

List any qualifications, certificates and licenses completed, beginning with the most recent.
Title / Organization / Start Date
(M/D/Y) / End Date
(M/D/Y)

IV Distinctions

Starting with the most recent, list post secondary honours, awards and scholarships, including name of awarding organization and date awarded. For monetary awards, include the start and end dates, value of the award and yearly stipend.
Name of Award / Award Value / Awarding Organization / Date Awarded / Start Date
End Date
(MM/YYYY) / Yearly Stipend
Name of Candidate
Distinctions (Continued)
Name of Award / Award Value / Awarding Organization / Date Awarded / Start Date
End Date
(MM/YYYY) / Yearly Stipend
V Publications
List all publications over course of career on the following page. Additional pages may be added, if required. If a paper has recently been accepted for publication or is in press, please attach acceptance letter.
Examples of publications include:
Refereed Papers (original articles published in journals with editorial review)
Books and Monographs (as author or editor)
Book Chapters/Contributions to a collective work derived from conferences or symposiums
Abstracts/Notes (including name of journal and title or article and date submitted)
Invited Presentations (including conferences, presentations, demonstrations, workshops destined for a non-academic audience)
Patents submitted or held
Publications
Name of Candidate
Publications (Continued)
Name of Candidate
VI Research Proposal
Title of proposed research project (12 words or less):
Provide up to 10 keywords to describe this research project:
Proposed STARS21 supervisor name, department, and institution (with address) at which you wish to carry out research training:
For Re-submissions, applicants can provide an additional maximum 2-pages, single-spaced, font 12 Response to Previous Reviewers' Comments.
Proposed project duration (1 or 2 years):
For Re-submissions, applicants can provide an additional maximum 2-pages, single-spaced, font 12 Response to Previous Reviewers' Comments.
Nature of the Proposed Research:
Describe the rationale, objective and experimental approach, as well as timeline of the proposed research. Highlight its relevance to the field of radiation medicine and the transdisciplinary nature of the project, clearly defining your role within the collaborative project.
Not to exceed the space provided. Applications should be single-spaced using a font no smaller than 12 point. Condensed types of spacing will not be acceptable.
Applicants are expected to discuss their application and proposed project with their supervisor or potential supervisors.
Proposed Research Project:
Name of Candidate
Proposed Research Project (Continued)
It is expected that this was written collaboratively by applicant and supervisor.
Name of Candidate
VII Letter of Intent
In the space provided, state how the STARS21 program, as you perceive it, will help you achieve your long-term career goals as an independent researcher. Tell us why you want to do transdisciplinary radiation medicine research, what you expect to get out of this program and how you plan to contribute to the institution at which you wish to carry out your training.
Name of Candidate
VIII Referees

Candidates must ask three individuals to provide assessments on their behalf. These should include (if applicable) an assessment from your most recent research supervisor. Give the names of the individuals whose assessments accompany this application.

Name of Referee/

Relationship to Candidate /

Current Position Held

Institution