Application form for graduate studies at IRIC
IDENTIFICATION AND CONTACT INFORMATION
First name
Last name
Gender
M
Country of birth
Date of birth (YYYY-MM-DD)
F
Status in Canada
Canadian citizen
Permanent resident
International student
Mailing address
Email
Phone (999-999-9999)
Skype Account
Language skills
Fr
Eng
Reading skills
Fr
CHOICE OF STUDY PROGRAM
I would like to join IRIC to pursue graduate studies at the:
M.Sc. level
Ph.D. level
In the following program from Université de Montréal:
Systems Biology
Other program, please specify:
I would like to start my training at IRIC:
Semester:
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
Model organism - C. albicans
Model organism - C. elegans
Model organism - D. melanogaster
Model organism - M. musculus
Model organism - S. cerevisiae
Model organism - X. laevis
Molecular and 3D modeling
Molecular biology
Nuclear receptors
Other (specify) :
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Oncogenes
Pharmacology
Proteomics
Sequencing
Stem cells
Synthetic biology
Systems biology
Telomeres
Transcription factors
Transgenesis
Tumor development
Vesicular transport
Virology
Eng
Application form for graduate studies at IRIC
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 for graduate studies at IRIC
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 for graduate studies at IRIC
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 for graduate studies at IRIC
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
SOURCES OF INFORMATION
Do you follow IRIC on Facebook?
Do you follow IRIC on Twitter?
www.facebook.com/iric.udem
www.twitter.com/IRIC_UdeM
Yes
Yes
No
No
How did you hear about IRIC for the first time?
IRIC website
Family / Friend / Colleague
Visit of IRIC
Teacher (specifiy name) :
Facebook
IRIC Pizza Slice & Science Lunches
Twitter
IRIC Next Generation Internship Awards program
Advertisement on UdeM campus
Université de Montréal open house
Advertisement on another campus
Scientific event (specifiy name) :
Television / Radio
Graduate studies fair (specifiy name) :
Newspaper / Magazine
Other website (specify) :
Scientific publication
Other (specify) :
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