Mitacs Globalink Partnership Award

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Mitacs Globalink Partnership Award

For graduate research in industry outside Canada

Instructions

Please refer to:

• Applicants should apply at least 12 weeks before departure to ensure enough time for pre-departure planning. Please allow 6 weeks for Mitacs to review your application.
• Send a draft of your proposal to yourMitacs Business Development Representativeprior to obtaining all signatures and submitting.
• Partner funds must be sent directly to Mitacs in Canadian dollars upon approval of the award proposal.

Please note:

• If required, your Mitacs Business Development Representative can assist you with:
• identifying your Office of Research Services (ORS) representative.
• Identifying your university International representative.
• facilitating the arrangement of non-disclosure agreements or intellectual property agreements.

A COMPLETE research project application package must include the following*:

The Globalink Partnership Awardproposal application duly completed and signedby all parties

Student CV (a CV Template is found on Mitacs website)

Mitacs Student Code of Conduct and Ethics*

International Pre-departure Form*

Any Supplementary Documents (as applicable)*

An incomplete application may result in a delay in the internship evaluation process.

*Please note that International Pre-departure Form, Mitacs Student Code of Conduct and Ethics and any supplementary documents may be forwarded at Mitacs after submission of your application; however, funds cannot be released until Mitacs receives these forms.

For more information, please visit:

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Mitacs Globalink Partnership Award Application Package – April 2014

1.0 Research Project Details

1.1.Research Areas:
(3 min-10 specific keywords: 50% technical related, 50% discipline related)
1.2.Title of project: / [Title] /
1.3.Academic Discipline: / Business / Life Sciences
Computer Science / Social Sciences, Arts & Humanities
Earth Sciences / Physical Sciences
Engineering / Mathematical Sciences
1.4.Proposed period of project: / Project Start Date: / Click here to enter a date. /
Project End Date: / Click here to enter a date. /
Student Travel Start Date: / Click here to enter a date. /
Student Travel End Date: / Click here to enter a date. /

1.5.City and country location abroad for research project with industry partner

1.6.Does this project create new international collaborations?

Yes No

1.7.Is this project connected with an existing international collaboration?

Yes No

If yes, pleasedescribe briefly (include a summary of the collaboration and length of time, and any past exchange of personnel, etc.)

1.8.Project Priority Sectors:Please rank up to 3top Priority sector(s) your project is addressing:

Aboriginal Affairs / Entertainment & Media / Natural Resources
Advanced Manufacturing / Environmental Science & Technology / New & Digital Media
Aerospace / Finance & Insurance / Ocean Tech
Agriculture & Food / Forestry / Oil & Gas
Aquaculture & Fishing / Green/Alternative Energy / Pharmaceuticals
Automotive / Health and Related Sciences & Technology / Public Service, Policy, & Governance
Biotechnology / Information & Communications Technology / Sustainability & the Environment
Clean Technology / Life Sciences (not health) / Technology
Commercial Services / Manufacturing & Construction / Tourism
Construction / Mining / Transportation
Education / Nanotechnology / Water
Energy & Utilities / Natural Gas / Other (please describe):

1.9.How did the project participants first hear about Mitacs?

Notification from your university department or at the university (bulletin board posting, email communication, newsletter, university website)
From the University's graduate studies department
From a colleague (professor at the university)
From a colleague (at the sponsor company)
Contacted by a Mitacs representative
Other (please describe):

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Mitacs Globalink Partnership Award Application Package – April 2014

2.0. Participants

2.1.Academic Supervisor:

Name:
University:
Department:
Address (at university)
City, Province:
Postal Code
Phone:
Email:
Québec Only: Please provide your PIN FRQ (ABCDE1234 format):

For any additional academic supervisors (copy and paste Section 2.1.) here:

2.2.Student:

Name:
Degree Program (Masters, PhD):
University:
Department:
Address (at university)
City, Province:
Postal Code
Phone:
University Email:
Alternate Email:
Citizenship:Please indicate if you are:
Canadian:
Permanent Resident:
Foreign:
Gender: Please indicate if you are:
Male:
Female:

*OPTIONAL* information requested. Please note that the following questions are voluntary and opting to not answer these questions will not impact your application. Our funding partners have requested the following information strictly for reporting purposes.

Please indicate if you are:

Francophone:
Aboriginal:
Person with a disability:
First in your family to attend university:

Social Media

I agree to provide my LinkedIn, Twitter and/or Facebook contact information authorizing Mitacs to connect with me for communication purposes during and after my program tenure:

LinkedIn:
Twitter
Facebook

2.3.Partner Organization:

Organization Name:
Contact Name:
Position:
Department:
Address 1:
Address 2:
City, Country:
Country Code
Phone:
Email:
Company website:
Partner Company Size (No. employees) / · 0 to 49
· 50 to 99
· 100 to 499
· 500 and higher

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Mitacs Globalink Partnership Award Application Package – April 2014

3.0. Research Proposal

3.1.Description of Proposed Research (approximately 1-2 pages):

Include the following mandatory sub-sections:

1. Background and appropriate review of relevant prior work (plus references)
2. Objectives of the research project
3. Relevance to the partner organization.

3.2.Details of the Student

For the student, include the following mandatory information

1. Objectives – indicate the specific project objectives for which the student is responsible
2. Methodologies – describe methodologies and novelty of approach/applications to be used by the student to achieve the described objectives
3. Timelines and milestones
4. Benefit to the student
5. Interaction - cleardescription of the student's interaction with the partner organization, including the amount of time (number of weeks or % of time) to be spent at the partner siteand the activities to be undertaken.Expected interaction is 75% at the partner organization and 25% at the home Canadian university.

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Mitacs Globalink Partnership Award Application Package – April 2014

4.0. Declarations

4.1.Is theacademic supervisor and/or intern:

An owner or a co-owner of the partner organization: / __Yes __No / OR
A relative of an owner or co-owner of the partner organization: / __Yes __No / OR
An employee of and / or a participant in the day-to-day management of the organization: / __Yes __No

If yes to any of the above, please complete the Conflict of Interest Declaration.

4.2.Will the proposed research be taking place outside of the lab or normal business environment? __Yes __No

If yes, please complete the following section to indicate what, if any, impact there may be on the environment.

4.2.1.Main characteristics of the location (i.e. physical description & coordinates)

4.2.2.Principal activity(ies): for each activity, list the environmental elements affected

4.2.3.Are authorizations, permits, or licenses required to undertake any activity during the internship? __Yes __No

If yes, please list and include copies with your proposal.

4.3.Does the proposed research involve living human subjects (includes conducting interviews) or human remains, cadavers, tissues, biological fluids, embryos or fetuses? __Yes __No

If yes, the proposal must be reviewed by the participating University Research Ethics Board, and a report by the board must be forwarded to Mitacs as soon as available.

Please note: funds cannot be released until Mitacs has received the report.

4.4.Does the proposed research involve animal subjects?__Yes __No

If yes, the proposal must be reviewed by the participating University Animal Care Committee and a report from the committee must be forwarded to Mitacs as soon as available.

Please note: no funds can be released until Mitacs has received the report.

4.5.Is a biohazards review required?__Yes __No

If yes, the necessary review/report from your University must be forwarded to Mitacs when available.

Please note: no funds can be released until Mitacs has received the report.

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Mitacs Globalink Partnership Award Application Package – April 2014

5.0. Project Budget and Invoicing

5.1. Proposed budget

Amount
Mitacs Contribution (total) - $7,500 / $
Partner Contribution (total) - $7,500Canadian / $
Total Award / $
Expenses
Total Student Stipend (for a 4-6 month research project, the student stipend must be a minimum of $10,000) / $
Total Travel Costs: a minimum $2,500 must go towards student travel costs associated with the research project / $
Total Research Costs (e.g. equipment, conference attendance, etc.) / $
Total Expenses ( = Total Award) / $

Please indicate if any of the following additional resources will be provided to the student

Additional resources / Amount
Office / Supplies / Stationary / $
Use of equipment or specialized equipment / $
Access to relevant company material, personnel / $
Industrial Partner Supervision / $
Other, please specify: / $

5.2.Invoicing

Invoicing Information

Please fill out the following in order to provide Mitacs with how you would like to be invoiced for this project.

Do you have specific invoicing requirements? (Vendor setup, PO, etc.)
Please state them here :
Do you require a paper copy of this invoice? ___ Yes ___ No
Contact Name:
Email:
___ Address same as listed in Section 2.3.
___ If invoicing address different than Section 2.3 please fill out the following:
Address:
City, Country:
Country Code:
Phone:

Partner Funds ** Please note: all partner contributions must be received by Mitacs in Canadian dollars **

• Have these funds been leveraged against other federal or provincial programs? If yes, please provide details:

/ __Yes __No

• Were partner funds sent, as an exception, to the university

/ __Yes __No
If yes, does the ORS agree to send these funds to Mitacs to match? Please name the key ORS contact: / __Yes __No

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Mitacs Globalink Partnership Award Application Package – April 2014

6.0. Suggested Reviewers

Please provide the names and contact information of at least THREE (3) expert arms-length reviewers who are competent to assess the technical aspects of the research proposal, whom Mitacs may contact for peer review of the research proposal.

An arms-length reviewer must:

-Be a recognized expert in the research topics covered by the proposal;

-NOT be from the same university as the student or the academic supervisor; and

-NOT have had any collaboration with the student or the academic supervisor during the past 5 years or planned for the near future.

Please note that peer review of proposals is a key aspect in assessing the suitability of your application. Neglecting to suggest reviewers who qualify as arms-length will delay the review of your application.

Reviewer 1:

Name:
University:
Department:
Email:

Reviewer 2:

Name:
University:
Department:
Email:

Reviewer 3:

Name:
University:
Department:
Email:

OPTIONAL: Potential Competing Interest. Include potential reviewers whom Mitacs should not contact because they might have a potential competing interest in the proposed research.

Name:
University / Research Group:
Name:
University / Research Group:

Other:

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Mitacs Globalink Partnership Award Application Package – April 2014

7.0. Mitacs Globalink Partnership Award Memorandum

The participants listed below have agreed to set in place a research project based upon the attached proposal. It is understood that the sponsor organization contribution shall be provided in Canadian dollarsto Mitacs Inc. prior to commencement of the research project; in the event that the sponsor organization funds are at the university, the university shall forward these funds to Mitacs. Upon scientific approval, Mitacs shall forward the funds to the university as a research grant to the supervising professor, and the student stipend shall be paid to the student by the university from the grant. Mitacs is unable to assume liability for any losses including - but not limited to -accidents, illness, travel or other losses that may occur during the researchperiod. All undersigned parties agree that they are responsible for ensuring that they have appropriate insurance and meeting any university policies regarding health and safety or travel preparation requirements. All parties also agree that the student is expected to provide Mitacs with a final completion report and all participants will complete an exit survey withinone (1)month of project completion.

In acknowledging that international exposure can greatly enhance a student’s learning and experience, Mitacs will approve international travel provided that participation does not impact the safety and security of the student and meets the policies outlined by the home Canadian university. By signing this memorandum, you are acknowledging that the home Canadian university agrees to assist the student in meeting all university requirements pertaining to research abroad and that the student understands that he/she is responsible for obtaining insurance appropriate for the travel destination.

All parties involved with Mitacs Globalink Partnership Award are bound by the standard intellectual property terms of the university where the student is enrolled; except where Intellectual Property is covered byseparate agreements towhich the university and thesponsororganization are parties and which are active during the dates of the research project. By signing this memorandum, you are acknowledging that you agree to the terms of the university where the student is enrolled.

The participants listed below also agree that Mitacs can disclose personal information included in this proposal to the program’s funding partners for the purpose of evaluating the program and its outcomes.

The Internship Participants (Intern, Supervising Professor, and Industrial Partner) further agree to the following addendum(s):

Mitacs does not require, inspect, or enforce any additional terms as outlined by participants in the above addendum.

**Please note that the following information including the title of the project, description of research project, name of the sponsor organization, name of student, name of supervisor and involved university will be posted under Internship Examples on and may be used by Mitacs to publicize Mitacs Globalink Partnership Awards**

7.1. Title of Project: [Title]

7.2. Project Overview: Using simplified language understandable to a layperson; providea general, one-paragraph description of the proposed research project to be undertaken by the student(s) as well as the expected benefit to the partner organization. (Approx 150 words)

7.3.Participant Signatures:

Student:

Name:
Department:
University:
Signature:______/ Date:

Academic Supervisor:

Name:
Department:
University:
Signature:______/ Date:

Partner Organization:

Name:
Department:
University:
Signature:______/ Date:

University Office of Research Service Representative:

Name:
Department:
University:
Signature:______/ Date:

For any additional participants include corresponding details and signature line here:

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Mitacs Globalink Partnership Award Application Package – April 2014