Summer Student Award Program 2017
Supervisor Endorsement /

StudentApplicant

Last Name / First Name / App. # / SSA 2017-##

To the Supervisor

This completed form should be no longer than three pages. Please note that your comments will be kept confidential.

Please submit this form directly to CFN at . Please name this document using this formatSSA2017_StudentSurname_SupervisorSurname.

Your endorsement must be received by CFN by 12 noon ET on Tuesday, February 28, 2017. If it is not received by the deadline, the Student Applicant will not be considered.

Last Name / First Name
Designations / E-mail address
How long have you known the applicant? / In what context?

Impact and Relevance

Very briefly describe your professional relationship with the applicant, including commenting on your willingness/capability to supervise and support the student in completing his/her summer activities.

Student Evaluation

Describe the student’s best characteristics, key competencies and capabilities.

How will the student benefit from receiving a CFN Summer Student Award?

Research Ethics/Environmental Assessment

If the student is conducting a research project, please answer the following two questions.

  1. Research Ethics: If the proposed research project involves biohazards, humans, human embryonic stem cells or animals, AND is funded by the Network, you must obtain certification of approval by your institutional certification committee before funds will be released.

⃝ Yes, I expect that this research will require an ethics review

⃝ No, I do not expect that this research will require an ethics review

  1. Does any phase or part of the research described in this proposal a) take place outside an office or laboratory, or b) involve an undertaking as described in part 1 of Appendix B of the Natural Sciences and Engineering Research Council of Canada (NSERC) Form 101?

⃝ No⃝ Yes

If you answered yes to this question, and you are selected for the program, your supervisor will be required to complete an Environmental Assessment Impact Statement and the Canadian Environmental Assessment Act Pre-Screening Checklist for review and approval by CFN before funds will be released.

Signature

 I wish to be added to the CFN mailing list (notification of funding opportunities, Network changes, etc.).
I, the undersigned, having read the CFN 2017 Summer Student AwardProgram Guidelines and reviewed the applicant’s completed application, declare that to the best of my knowledge the applicant meets the eligibility guidelines and has received no overlapping funding, that I am aware of my responsibilities under the Program and that I have the time and resources required to fulfill these responsibilities.
I understand and acknowledge that I will be required to obtain all ethics approvals and/or environmental assessments required pertaining to the applicant’s work (if required), that as the student’s supervisor I will provide at least 100% matching eligible funds to those provided by CFN, that these funds and CFN funds will go solely to go towards my student’s salary and benefits, that funding will go to my host institution, and that to receive funding I and my institution must be eligible to receive funding under Tri-Agency Guidelines, and must enter into a CFN Network Agreement and agree to administer the Award as per Tri-Agency and CFN Terms and Conditions.
I declare that I have provided true, complete and accurate information in all aspects of this form, and that to the best of my knowledge the applicant has also been truthful in the documents submitted as part of the application. I understand that CFN has the right to reject an application or retract the award on the basis of false or misleading information forming any part of a CFN Summer Student Award application. If any circumstances pertaining to this application change, including other funding or the applicant’s or my capacity to successfully complete the Program, I agree that I will immediately advise the CFN Executive Director.
Signature / Date

Host Institution of the Supervisor Named Above

Last Name / First Name
Institution

I, the undersigned, acknowledge that the Institution named above is aware that the fellowship applicant and supervisor named above have applied for funding from Canadian Frailty Network (CFN), a national research network funded by Industry Canada and Health Canada through the Networks of Centres of Excellence (NCE) program.

Signature / Date
Vice-President, Research, of the Institution named above (or authorized delegate)

™ Trademark of Technology Evaluation in the Elderly Network (Canadian Frailty Network or CFN, formerly known as TVN). © Canadian Frailty Network, 2013-17. Released 2017 01. CFN is supported by the Government of Canada through the Networks of Centres of Excellence (NCE) program.