Heart and Stroke Foundation of Ontario

Heart and Stroke Foundation of ONTARIO (HSFO)

Summer studentship Application FORM

APPLICATION CHECKLIST

ONE ORIGINAL AND ONE COPY (TOTAL 2) of the full application are to be submitted to the HSFO by March 15. The complete application must include:

Completed Application Form.

Official transcripts.Note: for students in their first year of university, statements from professors indicating the student’s current standing in courses not completed at the time of application should be provided.

A statement by the supervisor about the research project including project title that the student will be working on (limited to one typed page, single spaced). The supervisory statement should include a clear description of the role of the student in the research project and the benefits of the research experience to the student.

Details of current on-going grant funding and/or personnel support held by the supervisor. Please use the table on page 2 of this form or include “Funds Currently Held”page in Common CV with this application.

A short letter (limited to one page, single spaced) from the student outlining their summer employment experience, awards received, involvement in extracurricular activities, their objectives in applying for a summer research scholarship and their plans for further education.

SECTION A: APPLICANT AND PROJECT INFORMATION

Family Name / Given Name and Middle Initial(s)
Salutation
*Date of Birth (mm/dd/yyyy) / Male Female
*Providing your date of birth on the application form is optional. However, this information will ensure accurate identification of applicants and will assist the HSFO with statistical purposes. This information will not be transmitted to any entity outside of the Heart and Stroke Foundation.
Primary/Permanent Address / Address while at University / Contact Information:
Street Address:
Apt.:
City:
Province:
Postal Code: / Street Address:
Apt.:
City:
Province:
Postal Code: / Phone
Primary:
Secondary:
Fax
E-mail:
Title of research project (14 words or less)
Institution (where funds will be administered on behalf of the Foundation):

SECTION B: SUPERVISOR INFORMATION

Family Name / Given Name and Middle Initial(s)
Salutation
Primary/Permanent Address / Contact Information:
Street Address:
Apt.:
City:
Province:
Postal Code: / Position Title:
University/Hospital:
Department: / Phone
Primary:
Secondary:
Fax
E-mail:
Details of on-going grant funding and/or personnel support held by the supervisor (please complete the table below or include “Funds Currently Held” page in Common CV)
Grant/award title / Your role / Funding source / Amount awarded / Duration of grant/award(mm/yyyy – mm/yyyy)

Does the project on which the application is based involve human pluripotent stem cells? Yes No

Please note: all official correspondence will be sent to the primary address unless otherwise directed.

If awarded, I agree to abide by the regulations governing this award.

Applicant SignatureDateSupervisor Signature Date