Canadian Hearth Rhythm Society
George Mines Travelling Fellowship
George Mines Fellowship Application
The application needs to be received by chrs@ccs.ca before the posted deadline.
The George Mines Fellowship will provide recognition and funding to outstanding Canadian arrhythmia specialists
early in their careers, and provide a reliable supply of future Canadian leaders in this field. To do this it supports
training abroad for Canadian Arrhythmia Fellows, with the intent of acquiring advanced academic arrhythmia
clinical, research and/or educational skills. The George Mines Fellows will be exceptional candidates who will
become leaders in academic arrhythmia care in Canada.
Funds from the Fellowship will be awarded for a one-year period (July 1st to June 30th, academic year), but
candidates may discuss with the Awards Committee the possibility of spreading the award over two years.
Eligible criteria:
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Candidate will be permanent residents or citizens of Canada
Candidates will be physicians currently training in a Canadian cardiology or cardiac arrhythmia programme
Candidates will be members of the Canadian Heart Rhythm Society
Candidates will be eligible regardless of whether or not they hold advanced degrees in research or education
Candidates must have arranged for a position in an excellent academic training program outside of Canada
*Clinical fellowships without a strong academic focus are not eligible
*Preference will be given to fellows who have an offer of employment in a Canadian academic arrhythmia
center
Selection criteria:
George Mines Fellowships will be awarded to extraordinary applicants on the basis of several criteria, your
application must include:
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The George Mines Fellowship application form
Canadian permanent resident document, if applicable
Proof of licensure to practice medicine in Canada
Up to 3 best publications
A description of the proposed research project
Two page maximum - Describe the rationale, objective and experimental approach of your research project or
proposed research plan (include general timelines). State its relevance to the cardiovascular field.
Applications should be singles paced using a font no smaller than 12 point. Condensed type of spacing will not
be acceptable.
PLEASE ATTACH AS SEPARATE PAGES
Statement of commitment and training expectations
One page maximum - Note that it must be documented that you have dedicated time and effort to your
cardiovascular research project(s).
PLEASE ATTACH AS SEPARATE PAGES.
Provide an overview describing:
 the progress that you’ve made towards establishing your cardiovascular research career to date
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Canadian Hearth Rhythm Society
George Mines Travelling Fellowship
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how the training you expect to acquire will help you realize your long-term goals as an independent
researcher and how it will contribute to your research achievement and productivity
 your career expectations at the completion of the training (please indicate where you hope to be located)
 how you will eventually combine research and clinical practice (if applicable)
 The quality of the proposed training site, including quality of the training programme and where
appropriate research profile
 The quality of the proposed supervisor
 Whether an advanced degree will be sought
Two letters of appraisal from individuals involved in training the fellow in Canada
A letter of support from the proposed adviser, supervisor, or sponsor that stipulates:
 the proportion of time allotted to the clinical care, clinical education, and academic components
 the funding available for support of the fellow
A letter from the Head of Cardiology in the applicant’s centre appraising their future contributions to
arrhythmia care, research, and education in Canada
The George Mines Fellow will present a lecture summarizing the research or educational skills that were acquired
during the fellowship period. This lecture will be open to all members of the CHRS and any supporting partners.
The venue for the lecture will either be the Canadian Cardiovascular Congress or the CHRS Annual Meeting.
The complete application, including letters of support, must be received by chrs@ccs.ca before the
posted deadline. Late submissions will not be considered.
Submit to the address below (use email as fist option)
Canadian Heart Rhythm Society
co/ George Mines
222 Queen Street suite 1403
Ottawa, ON
K1P 5V9
Phone: (877) 569-3407
Email: chrs@ccs.ca
Program Start Dates: (Please check the start date you are applying for)
July 1 (current year)
A later date (please stipulate :_____________)
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Canadian Hearth Rhythm Society
George Mines Travelling Fellowship
CANDIDATE BACKGROUND AND CONTACT INFORMATION
Name: Surname/Last Name
Given Name/First Name
Initials
Maiden name if applicable
Correspondence Language
Date of Birth (yy/mm/dd):
Status in Canada:
Permanent Resident
Country of Citizenship:
Student VISA
Employment Authorization
Canadian
Other
Home Mailing Address:
Address:
City:
Province:
Postal Code:
Province:
Postal Code:
Academic Mailing Address:
Room # and Street Address:
University:
City:
Contact information :
Home Phone:
Work Phone:
Pager:
Email Address:
Cell Phone:
Language Skills: (please indicat a yes or no, and comment if necessary
Language
Read
Write
Speak
English:
French:
Other:
Signature of:
Candidate:
Proposed Supervisor:
Printed Name:
Understand
Date:
You may use either electronic signatures, or ink signatures following which you can scan the paper document into electronic format.
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Canadian Hearth Rhythm Society
George Mines Travelling Fellowship
CANDIDATE RESEARCH AND PROGRAM INFORMATION
Learning how to do research well involves learning a specific set of skills. This is usually done best in a graduate program, although some young
investigators acquire the skills in an apprenticeship. In this section please tell us about your plans for learning how to do research.
CHRS Mines applicants who do not already hold a PhD should ideally spend a minimum of two years engaged in full-time study in a research
program leading to a Master or PhD degree. Your graduate program may be requested to forward your complete application for review.
What are your plans for enrolment into graduate studies? (please check one or more):
Won’t apply to graduate program(s)
Have applied to graduate program(s)
(Specify Program)
Have been accepted into graduate program
(Specify Program)
Have already started graduate studies
(Specify Program)
Entering postdoctoral program(s)
(Specify Program)
Anticipated start date and completion date of graduate or postdoctoral studies:
Start Date: YR/MO
End Date: YR/MO
Source(s) of Other Research or Studentship/Fellowship Funding if applicable (also include any that have been
applied for):
Funding Source and Program:
Research Funding
Amount:
Studentship/Fellowship Funding
Start Date: YR/MO
End Date: YR/MO
Received
Applied for (specify when you expect to hear results)
Proposed Research Program
Graduate School Pathway
Non-Graduate School Pathway
Specify program and department
Master
PhD (specify program and department)
PDF (specify faculty and department)
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Canadian Hearth Rhythm Society
George Mines Travelling Fellowship
CANDIDATE EDUCATION AND EXPERIENCE
List and describe your education and relevant experience
Education: List your degrees and diplomas with the most recent or in progress.
Degree
Institution and
Subject of degree
Supervisor
Country
Research experience: undergraduate and graduate research training experience.
Institution
Department
Supervisor
Qualifications, certificates and licenses completed.
Title
Organization
Academic and professional experience: Begin with your most recent
Position
Institution
Faculty/Department/School
Start Date
End Date
(MM/YYYY)
(MM/YYYY)
Start Date
End Date
(MM/YYYY)
(MM/YYYY)
Start Date
End Date
(MM/YYYY)
(MM/YYYY)
Start Date
End Date
(MM/YYYY)
(MM/YYYY)
Credentials – Title and Description
Recognition – Title, Institution, Amount
Honours and Awards
Academic Interruption (If there has been an interruption in your academic career please provide an explanation
indicating the period and reasons for the interruption.)
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Canadian Hearth Rhythm Society
George Mines Travelling Fellowship
Profile
Engaged in Clinical Research?
Research Interests:
Fields of Application:
Disciplines Trained In:
Areas of Research:
Research Centres:
Research Disciplines:
Affiliations The primary affiliation is denoted by (*)
Affiliation
Start Date (MM/YYYY)
End Date (MM/YYYY)
Research Funding History
Awarded – In point form please write title, project description, start & end date, funding sources, total funding,
principal investigator, competitive funding?
Contributions
Presentations
Date
Publications
Journal Articles
Date
Title, Location, Main Audience
Authors, title, publication, etc.
References
List the names and addresses of your three references.
Reference 1: your proposed supervisor
Name:
Email address:
Reference 2: your current cardiology or arrhythmia administrative leader
Name:
Email address:
Reference 3: an independent assessor of academic potential
Name:
Email address:
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