The 2017 Henrietta Ehler Summer Student Respiratory Research Awards

Submit complete application to the Education Coordinator () by 4 PM March 15, 2017

Section 1 – Student Applicant Information (to be completed by the applicant)

Title: / Surname: / Given name(s):
Mailing address: / City: / Province:
Postal code: / Phone number:
Date of birth (dd/mm/yy): / Have you previously applied to this program?
Yes No
Email address:
University: / Program/Department:
Medical school Undergraduate / Year of study:
Expected graduation date:
Expected start date: Expected end date:
Salary support is provided for a 14-week period from May to mid-August.
Successful applicants are required to attend a Summer Student Research Program orientation.
Selected your preferred date: [insert date] [insert date]
Have applications been made for other summer student awards? Yes No
If yes, list all institutions to which you have submitted and/or will be submitting application for summer student awards:

Transcripts

Transcripts for all post-secondary courses must be submitted. Transcripts must be official or copies may be certified (signed) by the proposed supervisor, department head or notary public. Uncertified copies will not be accepted. If marks are not complete, please submit the most up-to-date marks. Note for foreign transcripts a certified English translation and a clear explanation of the grading system must be included.

-1st Year Undergraduate students: Grade 12 transcript and transcripts for all post-secondary courses

-2nd, 3rd & 4th Year Undergraduate students: Transcripts for all post-secondary courses

-Medical students: Transcripts for all post-secondary courses(including medical school transcripts)

Section 2 – Supervisor Information (to be completed by the investigator)

Supervisors please note the following:

Applicants awarded studentships are expected to fulfill the requirementsof the Research Education Program as listed here:

  1. Attend an orientation session.
  2. Participate in the HLI Research in Progress seminar series held on Monday mornings from 9:00-10:00 AM.
  3. Prepare and present an oral presentation and a poster describing the results of their research for summer student research day in mid-August.

Lab work, meetings, and other aspects of their research project should therefore be scheduled accordingly. Failure to fully participate in the program may result in the withdrawal of the scholarship.

Title: / Surname: / Given name(s):
Academic appointment:
Department:
Mailing address: / City: / Province:
Postal code: / Phone number:
Email address:
Are you a member of HLI? Yes No

Section 3 – Research Project (to be completed by the applicant with the supervisor’s guidance)

The project application should make clear the:

  • Purpose and exact nature of the student project
  • Role and specific tasks of the student
  • Nature of the instruction and supervision to be provided for the student
  • Feasibility of completing the project given the time available
  • The potential benefits the applicant will gain from the experience

**Please use Arial 11 font, single spaced.

Project title:
Hypothesis/specific aims:
Background and experimental approach:
Project classification: Basic Science Clinical/Population Health/Health Sciences
Will the student be working in a wet lab? Yes No
Will the student be working with animals? Yes No
Has the project been approved by UBC Research Ethics Board? Yes No In Progress
It is agreed that the guidelines governing the applicant, which includes full participation in the program as outlined on page 2 are hereby accepted by the applicant, investigator and director.
Applicant / Investigator / Director, HLI
Name (print): / Name (print): / Name (print):
Signature: / Signature: / Signature:
Date: / Date: / Date:

One additional page may be added if necessary.

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