APPLICATION FORM
IDENTIFICATION AND CONTACT INFORMATION
First name
Last name
Gender
M
Country of birth
Date of birth (YYYY-MM-DD)
F
Status
Quebec resident
Canadian citizen
Permanent resident of Canada
International student, specify your country of citizenship:
Mailing address
Email
Phone (999-999-9999)
Skype Account
Language skills
Fr
Eng
Reading skills
Fr
TRAINING PROGRAM
I would like to join the IRIC to pursue a:
Masters (MSc) degree in the following program:
Systems Biology (fast-track 1-year program, includes 2 laboratory rotations)
Other program (2-year program)
Doctorate (PhD) degree in the following program:
Systems Biology (4-year to 5-year program)
Other program (4-year to 5-year program)
I would like to start my training at IRIC:
Term:
Summer (May)
Fall (September)
Winter (January)
Year:
RESEARCH INTERESTS
Check off the boxes corresponding to your research interests:
Antigen presentation
Autoimmune diseases
Biochemistry
Bio-imaging
Bioinformatics
Bone marrow transplant
Breast cancer
Cell biology
Cell differentiation
Cell division
Cell migration
Cell proliferation
Chemotherapy
Chromatin
Chromosomes
DNA damage
DNA microarrays
Drug discovery
Flow cytometry
Genetics
Genomics
Hematopoiesis
High-throughput screening
Histology
Histone acetylation
Immunology
Informatics
Intracellular signaling
Leukemia
Mass spectrometry
Medicinal chemistry
Membrane receptors
Metastases
Molecular and 3D modeling
Molecular biology
Nuclear receptors
Other (specify) :
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Pharmacology
Proteomics
Sequencing
Stem cells
Synthetic biology
Systems biology
Telomeres
Transcription factors
Transgenesis
Tumor development
Vesicular transport
Virology
Eng
APPLICATION FORM
ACADEMIC BACKGROUND
Outline your academic background; beginning with the most recent degree that you will have obtained prior to enrollment at IRIC:
Diploma (e.g. B.Sc., M.Sc., Ph.D.)
Name of the program / Field of study
Name of the university
City of the university
Year of enrollment
Year of graduation
Grade point average (GPA)
Country of the university
Maximum GPA possible
Diploma (e.g. B.Sc., M.Sc., Ph.D.)
Name of the program / Field of study
Name of the university
City of the university
Year of enrollment
Year of graduation
Grade point average (GPA)
Country of the university
Maximum GPA possible
Diploma (e.g. B.Sc., M.Sc., Ph.D.)
Name of the program / Field of study
Name of the university
City of the university
Year of enrollment
Year of graduation
Grade point average (GPA)
Maximum GPA possible
Name of the program / Field of study
Name of the university
City of the university
Year of graduation
Grade point average (GPA)
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Minimum passing GPA
Country of the university
Diploma (e.g. B.Sc., M.Sc., Ph.D.)
Year of enrollment
Minimum passing GPA
Minimum passing GPA
Country of the university
Maximum GPA possible
Minimum passing GPA
APPLICATION FORM
ACADEMIC AWARDS
Academic awards or scholarships that you have received
SCIENTIFIC PUBLICATIONS AND PRESENTATIONS
Contributions to scientific publications (references only)
Oral or poster presentations during scientific meetings (name, location and date of the meeting, title of your presentation)
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APPLICATION FORM
RESEARCH EXPERIENCE
Indicate any relevant research experience (e.g. internship, summer job in a lab), from the most recent to the oldest:
Name of employer
Name and email address of your supervisor
Position you occupied
Description of your responsibilities
Name of employer
Name and email address of your supervisor
Position you occupied
Description of your responsibilities
Name of employer
Name and email address of your supervisor
Position you occupied
Description of your responsibilities
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APPLICATION FORM
REFERENCES
Provide details of a minimum of two persons who will act as referees in support of your application (only mandatory for Ph.D. candidates)
First and last name
Employer
Position occupied
Email address
First and last name
Employer
Position occupied
Email address
OTHER
Do you follow IRIC on Facebook?
Yes
Do you follow IRIC on Twitter?
No
Yes
No
How did you hear about the IRIC for the very first time?
IRIC website
Other website, specify:
IRIC Next Generation Awards program
Graduate school fair or other recruitment event, specify:
Scientific meeting, specify:
Promotional flyer/poster on the campus of the UdeM
Promotional flyer/poster on the campus of another university
COOP or internship database, specify:
Teacher or program coordinator, specify:
Student association, specify:
Current or past member of the IRIC, specify:
Friend or family member
Other, specify:
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Do you follow IRIC on LinkedIn?
Yes
No