Bluma Tischler Application Form - Graduate & Postdoctoral Studies

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Faculty of Medicine
Bluma Tischler Postdoctoral Fellowship
The Bluma Tischler Postdoctoral Fellowship Award is for MD or PhD graduates in medicine, biochemistry,
genetics or associated disciplines carrying out research on the biochemical or genetic aspects of mental
retardation or other neurological disorders.
AWARD
$20,400 for one year. Holders of the award may apply for a second year.
ELIGIBILITY
Applicants must hold a postdoctoral appointment at the University of British Columbia for the full duration
of the fellowship. No citizenship restrictions apply.
APPLICATION PROCEDURES
A completed application consists of:
1. A completed application form (below)
2. Post-secondary transcripts from all post-secondary institutions attended
Copies of transcripts are accepted, but each page must be initialed by the proposed supervisor of the
candidate’s postdoctoral research. Initialing of official sealed transcripts is not required.
3. Letters of support from three sponsors
One letter should be from the proposed supervisor of the candidate, and the others from individuals familiar
with the candidate’s academic and research abilities. Sponsors are asked to comment on the applicant’s
research potential and achievements, interpersonal skills, academic abilities, and greatest strengths and
weaknesses. Letters should be addressed to the Executive Associate Dean, Research, and submitted in sealed
envelopes. Letters may be sent separately but must be received by the application deadline.
Submit complete application via mail to:
Dr. Howard Feldman
Executive Associate Dean, Research
c/o Lisa Ritland
Faculty of Medicine
317-2194 Health Sciences Mall, Vancouver BC, V6T 1Z3
Please do not use staples or print double sided.
DEADLINE TO APPLY: April 10, 2015 at 4:00pm
Please direct any questions about this award to Lisa Ritland at med.research@ubc.ca or 604-822-8633.
Faculty of Medicine
Bluma Tischler Postdoctoral Fellowship
APPLICATION FORM 2015
Applicant Last Name
Applicant First Name
Initials (s) of Middle Name(s)
Applicant Current Mailing Address
Applicant Permanent Mailing Address
Applicant Telephone Number(s)
Applicant Email Address
Start Date of UBC Postdoctoral Appointment (MM/YYYY)
Department of UBC Postdoctoral Appointment
UBC Supervisor
UBC Supervisor Email
Date MD or PhD Completed (MM/YYYY)
Institution MD or PhD Completed
Appointments held
Begin with your present appointment and list each appointment held since your first degree (e.g. Postdoctoral
Fellow, Research Assistant, etc.)
Position Title
Department
Institution
Period Held
(MM/YYYY–MM/YYYY)
Discipline
Institution
Date Received
(MM/YYYY)
Degrees and diplomas received
Degree/Diploma
1
Faculty of Medicine
Bluma Tischler Postdoctoral Fellowship
APPLICATION FORM 2015
Scholarships and other awards offered
Begin with your most recent award and list only competitive awards based on academic or research excellence
and/or leadership or communications abilities.
Name of Award
Annual Value
(CDN$)
Location of Tenure
2
Period Held
(MM/YYYY–MM/YYYY)
Faculty of Medicine
Bluma Tischler Postdoctoral Fellowship
APPLICATION FORM 2015
Publications
Begin with your most recent contributions and list each entry on a new line. Do not include any articles that are
currently in preparation or those on which you do not appear as an author. Use the following headings in the
order indicated:
a) Articles published or accepted in refereed journals
b) Articles submitted to refereed journals
c) Other refereed contributions
d) Non-refereed contributions
3
Faculty of Medicine
Bluma Tischler Postdoctoral Fellowship
APPLICATION FORM 2015
Publications (continued)
4
Faculty of Medicine
Bluma Tischler Postdoctoral Fellowship
APPLICATION FORM 2015
Proposed research project
Provide a brief summary of the proposed research project, including its relevance to the field of biochemical
and/or genetic aspects of mental retardation or neurologic disorders. Limit your summary to 750 words.
Title of Proposed Research Project
Summary of Proposed Research Project (maximum 750 words)
5
Faculty of Medicine
Bluma Tischler Postdoctoral Fellowship
APPLICATION FORM 2015
Sponsors
Name
Title
Address
Signatures
Applicant Signature
Date
Supervisor Signature
Date
Department Head Signature
Date
Attachments:
 All post-secondary transcripts (copies initialed by supervisor of postdoctoral fellowship accepted)
 Letters of support from three sponsors (including supervisor of postdoctoral fellowship) in sealed envelopes
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