NSERC USRA2018 Application Form – Departmental Application
This information is collected under the Freedom of Information and Protection of Privacy Act (FOIP). This is an internal application required to evaluate and rank the applicant for an NSERC Undergraduate Summer Research Award.
THIS PAGE TO BE COMPLETED BY THE APPLICANT (Please type)
Last Name (Family Name) / First Name / Middle Name(s)
Current Degree/Program / Year(2,3,4) / Home phone number / Email address
Cumulative GPA / Major GPA / Proposed Supervisor / Department
Have you held an NSERC USRA award before? If yes, please list supervisor name(s), location(s) and dates. / yes no
Supervisor / Location (Department/Institution) / Dates (yyyy/mm)
Are you currently enrolled in 59-410 or other honours project course? If yes, please list supervisor(s) and department(s) / yes no
Supervisor(s) / Department(s)
Have you had any research experience (i.e.., non-USRA: summer research, work study, technician, etc.)? If yes, please list supervisor(s), location(s) and dates. / yes no
Supervisor / Location (Department/Institution) / Dates (yyyy/mm – yyyy/mm)
Have you enrolled in or been accepted to a professional school (e.g., M.D., D.D.S, B.Sc. N., etc.)? / yes no
Have you obtained any other post-secondary degrees (e.g., B.Sc., B.A.. M.Sc., etc.)? If so please list here: / yes no
Research Contributions / Number / For students with previous research experience, please securely attach a list of publications, posters and/or conference presentations, with appropriate information on publishers, dates and/or locations.
Refereed publications
Poster presentations
Conference presentations
I certify that all of the above information is correct as of the date below, and understand that inaccuracies in the provided information may result in disqualification of this application. Be sure to hand in an official transcript and a completed NSERC Form 202.
Signature / Date
09/12/2018
Form last modified Jan. 9, 2018, version 2.1, RWS.