CSS (PGY1-4) Application Form
DEPARTMENT OF PSYCHIATRY
University of Toronto
APPLICATION FORM
2015-2016 Academic Year
Clinician Scientist Program
Centre for Addiction & Mental Health
250 College Street, Room 829
Toronto, Ontario M5T 1R8 http://www.psychiatry.utoronto.ca/research/clinician-scientist-program/
Complete all Sections. Please type or print clearly.
Incomplete or illegible forms cannot be processed.
Legal Surname All legal given names in full (Indicate most commonly used 1. Program Applied For:
CSS CSP
2. Former Surname
3. Sex 4. Date of Birth (yyyy/mm/dd) 5. Social Insurance Number
6. Present Mailing address Apt. #
City
No. & Street
Province Country
Area Code & Phone Number
Postal Code
7. Permanent Address Apt. #
City
No. & Street
Province
Area Code & Phone Number
Country Postal Code
8. Status in Canada
Authorization
11. First Language
9. Country of Citizenship
12. Email Address
10. Marital Status
RESEARCH PROJECT
Include an overview (1-3 pages for CSS, 3 pages for CSP) of the proposed research project according to the guidelines below
Rationale/background: why is the topic important? What is known thus far?
Purpose, aims and hypotheses: what is the overarching goal of the research? How will it advance knowledge? What aspects are novel? What are the specific hypotheses to be tested?
Methods: list specific aspects of study design including measures, timelines, sample characteristics, and overview of analytic approach. Has the data already been collected? *Will data be ready for analyses in time to ensure successful completion of
CSP?
Methods: list specific aspects of study design including measures, timelines, sample characteristics, and overview of analytic approach. Has the data already been collected? *Will data be ready for analyses in time to ensure successful completion of
CSP?
Environment: what resources and support are in place to assist the candidate? Who are the other members of the research team, in addition to the supervisor? What is the specific role of the candidate within the supervisor's program of research?
Anticipated deliverables including first-author conference presentations and publications (be as specific as possible)
Anticipated challenges to project and/or role of the student within project, and approach to these challenges
*Refers to CSP only
