REQUEST FOR POST-DOCTORAL FELLOW (PDF) OR VISITING SCHOLAR (VS) APPOINTMENT / RE-APPOINTMENT*
Office of the Vice-President (Research and Innovation)
Lakehead University, UC 2003, 955 Oliver Road
Thunder Bay, Ontario, P7B 5E1 (807) 343-8201
PERSONAL DATA (of PDF or VS)
Name:
SIN:
Address:
Citizenship:
Status in Canada (if not Canadian):
[ ] Permanent Resident [ ] Other: ______________________
Indicate date of landing as per FORM IMM 1000:
E-mail address:
Degrees and Granting Institutions:
APPOINTMENT INFORMATION
Type of Appointment:
Start Date:
[ ] Post-Doctoral Fellow (faculty grant funded)
[ ] Visiting Scholar (faculty grant funded)
[ ] Post-Doctoral Fellow (externally funded)
[ ] Visiting Scholar (externally funded)
End Date:
Fellowship (PDF) or Stipend (VS) Amount:
Funding Source
Please provide details specific to external financial support (including Lakehead University Account Number(s), and any special terms and conditions
related to external awards)
Name of Granting
Agency
Dates:
Account Number :
Supervising
Faculty Member:
SPECIAL TERMS:
Faculty/Dept:
Name or Description of Research Project:
Proposed Plan of Research:
Services Required:
[ ] Library Privileges
[ ] Computer Account
[ ] Other ___________________________
Description of Academic Support (to be
completed by Department/Program Chair)
[ ] Secretarial Assistance
[ ] Office Space / Lab Space
[ ] Telephone, Fax, Photocopying
[ ] Other – Please Specify:
ACCOMPANYING DOCUMENTATION:
[ ] Letter of Support signed by Faculty Supervisor
If any of the preceding types of academic
support have been selected, please specify
what arrangements have been made:
[ ] Curriculum Vitae (for PDF or VS) copy of doctorate diploma (for PDF only)
I hereby agree that any award/appointment made to me as a result of this application will be subject to the general conditions governing post-doctoral
fellowships and visiting scholars outlined in the document, Lakehead University: POLICY ON POSTDOCTORAL FELLOWS & VISITING SCHOLARS.
_______________________________________
Post-doctoral Fellow / Visiting Scholar
_____________
Date
_______________________________________
Faculty Supervisor / Sponsor
_____________
Date
_________________________________________
Signature of Faculty Dean
______________
Date
Appointment Authorized By:
_______________________________________
Signature of Department Chair/Director
_____________
Date
_____________________________________________________________
Signature of Vice-President (Research and Innovation)**
_________________________________________
Date
**This final signature is arranged by the Office of Research Services (please submit form to ORS after obtaining Dean’s signature)
*If this request is to renew a PDF or VS appointment is an Official Letter also required from the
University? Yes [ ]
No [ ]