Emergency and Seniors Health Strategic Clinical Network™

2017 Master’sStudentshipApplicationForm

ApplicantInformation
FirstName / Initial / Last Name
Address / E-mail
City / Province / PostalCode / Phone(Home) / Phone(Cell)
University(presentlyregistered) / Degree Program/Discipline
Thesis or Major ResearchProjectTitle / GPA
SupervisorInformation
Name / Email / Telephone / Fax
Institution / Program(Faculty/Department/Division)
Address / City / Province / PostalCode

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Emergency and Seniors Health SCN 2017Master’s Studentship Application Form

ProjectInformation
Brieflydescribethethesis or majorresearchproject.(750 wordsorless)
Describetheproject’salignmenttothemandates of the Emergency and Seniors Health SCNs.(200 wordsorless)
Describetheoriginality and significance of thethesis or major researchproject.(200 wordsorless)
Describehowthisthesis or major research projectcomplementsthe student’slong-termcareer plans.(200 wordsor less)
Describethetrainingenvironmentprovidedbythesupervisorand graduate program/university.(200 wordsorless)
Ethics
REB approval obtained (Please list institution and certificate number:______)
REB submission pending
REB approval not required
Timelines
Proposedtimelines oftheThesis or Major Research Project (list milestones and dates):
Signatures
______
StudentApplicantDate
______
SupervisorDate
Application Checklist
ApplicationForm
Applicant CV(4-pagemaximum, example template below)
Supervisor’sCV(4-page maximum, example template below)
Scanned Copy of Official Transcripts (all years of university education)
Letter of Support from supervisor
Pleasecarefullyread all instructionsand includeall necessary documents.
Incompleteapplications will be returned (if submitted before thedeadline) and will notbereviewed (if after the deadline).
Itisthestudent’s responsibilitytoensurethatthematerials havebeen successfullysubmitted
.

Student CV - Example Template (4 page max.)

APPLICANTNAME:

EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, and include postdoctoral training.)

INSTITUTION ANDLOCATION / DEGREE / YEAR(s) / FIELD OFSTUDY

RESEARCHPUBLICATIONS(ifany):(list)PRESENTATIONS:(list)

PUBLISHEDABSTRACTS:(list)RELEVANTCOURSEWORK:(list)

RESEARCHASSISTANTSHIPS:(list)

CURRENTSCHOLARSHIPSANDAWARDS:(list)

PAST SCHOLARSHIPSANDAWARDS:(list)

Supervisor CV - Example Template (4 page max.)

NAME:

POSITIONTITLE:

.

EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, and include postdoctoral training.)

INSTITUTION ANDLOCATION / DEGREE / YEAR(s) / FIELD OFSTUDY

PROFESSIONALEXPERIENCE/EMPLOYMENT(list)

Number in the last 5 years / Career Total
BOOKS/BOOK CHAPTERS
PEER-REVIWED PUBLICATIONS
PUBLISHED ABSTRACTS

SELECTED BOOKS/BOOK CHAPTERS:(please list the most relevant below)

SELECTEDPUBLICATIONS (please list the most relevant below):

CURRENTFUNDING:(list)

CURRENT/RECENT STUDENTSSUPERVISED(please list includingdegreeandcompletiondate, one page max):

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Emergency and Seniors Health SCN 2017Master’s Studentship Application Form