APPLICATION FOR A FELLOWSHIP
APPLICATION REQUIREMENTS
(a )
Su bm is s io n R e qu ir e m e n t s
1 PDF copy of the complete application sent by email to administration@cpqr.ca. The PDF should be a single file
containing all sections of the application form and all letters-of-recommendation, academic transcripts, appended
pages, etc., in the correct order. Both sides of transcripts, front and back, must be copied in the PDF. Applicants
must ensure that transcripts in the PDF are clear and legible. The PDF must also have bookmarks to each
individual section in the application form (i.e. Sections A: General Information to I: Undertaking of Institution or to
Section K: Research Facilities in Canada [if applicable] plus Letters-of-Recommendation and Academic Transcripts;
create bookmark links to go to these specific sections of the application). The PDF itself must be titled as follows:
Surname_given name_fellowship 2013 (i.e. Doe_John_CFC fellowship 2013)
(b )
C om plet i on of a ppli c a t i on
Sections A-D of the application form must be completed by the applicant.
( c)
D ea d li n e f or s u b m i s s i on s
This is an open call for applications however CPQR wishes to fill the position as soon as possible. With this in mind,
please advise CPQR as soon as possible if you are interested in submitting an application.
( d)
S up p o r ti ng d o c um e nta ti o n fo r su b m i s si o n
i.
Three letters of recommendation, one of which should be from your current or most recent supervisor,
must be included in the PDF.
Please contact Erika Brown, Program Lead, CPQR (administration@cpqr.ca ) at if you have any questions.
PLEASE REMOVE THIS COVER PAGE PRIOR TO SUBMITTING THE PDF APPLICATION FORM
10/2012
APPLICATION FOR A FELLOWSHIP
A. GENERAL INFORMATION
Name of applicant
(Title, Given Name, Middle Name, Surname)
Mailing address
Telephone
Fax
E-mail
Name and address of three references whom you have asked to provide letters of recommendation.
1.
2.
3.
Name and host institution of current supervisor
10/2012
APPLICATION FOR A FELLOWSHIP
B. EDUCATIONAL BACKGROUND
D eg rees h el d or ex pe c t ed
Degree
Start date
End date
Discipline
Institution
Supervisor (if applicable)
(dd/mm/yyyy date format)
Years and months of post-PhD academic experience as of November 1, 2012:
Po s tg r a d ua te tr a i ni ng
Please include all postgraduate training to date, including residency training and appointments held. M.D.
applicants, who received their medical degree four or more years prior to the date of application, must provide
details of any research training undertaken since receiving their degree.
Start date
End date
(dd/mm/yyyy date format)
Institution
Position
Supervisor
Di s t i n c t i o n s /aw ar d s
Please include all undergraduate and graduate awards, specifying dates held or received. Noteworthy invited
lectures may also be included.
Start date (mm/yyyy) End date (mm/yyyy)
Pub l i c a ti o ns
Please provide a list, with full references, of all papers and abstracts. Additional pages may be used, and should
be inserted following this page.
APPLICATION FOR A FELLOWSHIP
C. CAREER GOALS
Provide a brief description of your career goals, and explain how a CPQR Research Fellowship would help to
advance these goals.
APPLICATION FOR A FELLOWSHIP
D. UNDERTAKING OF APPLICANT
The undersigned hereby agrees that the conditions governing the award of a Fellowship, as detailed in the CPQR
Research Fellowship Outline, apply to any grant awarded under this application, and that these conditions are
accepted by the applicant.
Please note that M.D. applicants must be eligible for licensure, and must provide documentation from the
provincial licensing authority verifying such eligibility.
Signature of applicant
Date