Faculty of Graduate Studies
Department of Surgery
MSc Graduate Degree Program
APPLICATION GUIDE & SUPPLEMENTARY FORM
NOTE: Program start date is May 1st - Summer Term. Applicants must apply online through the Faculty of Graduate
Studies (FGS) admissions – UMGradConnect – Department application deadline is January 15th:
1. Please complete this form in its entirety, print and arrange a meeting with the Administrator
(surgery_graduate@umanitoba.ca) to review form and program requirements no later than December 15th.
http://umanitoba.ca/faculties/graduate_studies/admissions/index.html
2. A meeting must be arranged with the Department of Surgery Graduate Chair following this deadline before
approval for admissions with Graduate Studies will be granted. Department admissions deadline is February 1st.
Enter the text in the space provided. Space will expand as you insert your responses.
Student Information
Name:
UM Student Number:
Home Address:
Telephone:
Home
Cell
Email Address:
Residency Program:
Program Director:
Please list the Program Director for your postgraduate residency program as your 'Recommender' in your application. By
adding your program director as a recommender, the online system will generate an email to your program director asking
them to complete the Confidential Recommendation letter. In addition, your Program Director must include a letter of
recommendation regarding your postgraduate training as this is a requirement for the Department of Surgery MSc
Program. Please forward the PDF template found in the UMGradConnect on-line application to him/her requesting they
complete and upload the form along with the online Confidential Recommendation letter.
Program start date: May 1st - Summer term
Application Year for
Admissions:
Anticipated Date
of Graduation
February
May
October
Year:
Thesis Advisor
Please list him/her in 'Preferred Supervisor' field in the 'Program Details' section of your UMGradConnect application. Your
advisor should fill out and return the PDF form to you so you may upload it to your online application under the section
'Additional Requirements', question 'Supervisor Support'.
Name:
Email Address:
Surgical Specialty:
Page 1 of 6
MSc Program: Application Guide & Supplementary Form
Department of Surgery
Proposed Thesis Project
Proposed Research Focus (please check one):
Basic &/or Clinical
Laboratory Research
Clinical
Trial
Outcomes Research
(i.e. epidemiology)
Surgery Education
&/or Surgical Skills
Other Please specify:
Project Title:
Location / site where
study will take place:
Site (e.g. HSC, St Boniface, Victoria Hospital, John Buhler):
Laboratory
Office
Ethics
Please check () all applicable approvals required for project
Obtained
Pending
Not Applicable
Human Ethics*
Animal Ethics*
Biosafety
Other: (please list)
(* If approval received, please include a copy of the letter with your application)
Role in Study
Please outline what your role in the proposed research project will be:
Publications / Presentations / Further Study
Please describe what you foresee arising from this project:
Career & Research Plans
Please provide a maximum 450 word summary describing your career and research plans upon graduation:
Page 2 of 6
MSc Program: Application Guide & Supplementary Form
Department of Surgery
MSc Timeline (anticipated terms for course work (min: 12.0 credit hours), writing and defending thesis)
SUMMER TERM
Year:
FALL TERM
Year:
WINTER TERM
Year:
SPRING TERM
Year:
PREPARATION FOR DEFENCE
Year:
Page 3 of 6
MSc Program: Application Guide & Supplementary Form
Department of Surgery
Signatures
Applicant:
Date:
Program Director:
Date:
Thesis Advisor:
Date:
Please print and submit all pages to: Research & Graduate Office, AD210-Health Sciences Centre, 820
Sherbrook Street, Winnipeg Manitoba, R3A 1R9 or scan and email to: surgery_graduate@umanitoba.ca
Department of Surgery Approval
As Graduate Chair for the Department of Surgery Master of Science Program I have reviewed the applicant’s research
proposal; required documentation; and discussed the student’s expectation to complete the MSc Program in
conjunction with their postgraduate training program. Based on this information, admission to Faculty of Graduate
Studies is:
 APPROVED
 NOT APPROVED
Department of Surgery Graduate Chair
(or Designate)
Signature
FOR OFFICE USE ONLY





Date
DATE RECEIVED
Current CV provided
Outline of Proposed Research Project
Pre-Admissions Approval form completed including all required signatures
Thesis Advisor support letter received and uploaded to online UMGradConnect application
Program Director letter of recommendation confirmed received in UMGradConnect application
APPLICATION COMPLETE
YES
NO
MEETING DATE ____________________________
(with Graduate Chair or Designate)
Page 4 of 6
MSc Program: Application Guide & Supplementary Form
Department of Surgery
Maximum 5 pages (not including references) plus 2-3 figures as appendices, if applicable
Enter text in the space provided – space will expand as you insert your responses
Outline of Proposed Research Project
Background Information
Objectives
Hypothesis
Methods
Possible Pitfalls / Limitations
Summary / Relevance to Surgery
Budget / Funding Source
Page 5 of 6
MSc Program: Application Guide & Supplementary Form
Department of Surgery
References
Page 6 of 6