Rick Hansen “Man in Motion” Fellowship Application Form
2010-2011 Competition
The Rick Hansen “Man in Motion” Fellowships are made available by the University of British Columbia to honour
the incredible determination and many personal achievements of Rick Hansen, Bachelor (Physical Education),
1986 and Doctor of Laws, honoris causa. His two-year world tour, Man in Motion, completed in 1987, changed
public attitudes and the prospects for people with disabilities. Two fellowships, valued at $16,000 per year, are
awarded each year.
Eligibility Criteria
The competition is open to students with a physical disability. The definition of disability is outlined in UBC Policy
#73, Academic Accommodation of Students with Disabilities, as well as by the Disability Resource Centre.
Applicants may or may not be UBC graduate students at the time of application – the competition is open to both
incoming and continuing graduate students. However, awardees must be enrolled as full-time graduate students
at UBC for the academic year 2010-2011 in order to receive a Rick Hansen Fellowship through this competition.
Selection Criteria
Fellowship winners are selected on the basis of academic merit. Applications will be considered from students
with a good academic record (i.e. minimum high second class standing).
Student Application Process
Applicants must check with their graduate program regarding their program’s internal application deadline.
Internal application deadlines are normally several weeks before the Faculty of Graduate Studies deadline, as
departments must review students' applications well in advance of the Faculty of Graduate Studies deadline of 12
March 2010.
Applicants must submit the following materials to their graduate program at UBC:



Completed Rick Hansen “Man in Motion” Fellowships application form.
Academic records for all university-level studies (including studies undertaken but not completed) up to
31 December 2009. For institutions other than UBC, only official transcripts will be accepted. These may
be original or certified true copies provided by the applicant's graduate program. For UBC, the applicant's
"Academic History" printed from the SISC by the applicant's graduate program will be accepted. Please
note that students must request certified true copies of transcripts from their graduate program, not from
the Faculty of Graduate Studies.
Two letters of recommendation. Only recommendation letters signed by the person providing the
reference are acceptable; original, faxed, and scanned copies sent by e-mail are acceptable.
Please note:
The following Application Form is designed to be completed on your computer using the “TAB” key to navigate
through the document, with only the signature being hand-written.
Faculty of Graduate Studies, Awards
180-6371 Crescent Road
Vancouver, BC V6T 1Z2
Canada
2010-2011 Rick Hansen “Man in Motion” Fellowship Application Form
web: www.grad.ubc.ca/awards
e-mail: graduate.awards@ubc.ca
phone: 604-822-2848
fax: 604-822-5802
Instructions
Rick Hansen “Man in Motion” Fellowship Application Form
2010-2011 Competition
1.
Student Information
Last Name:
First Name:
Mailing Address:
City:
Province:
Postal Code:
E-Mail:
Home Phone:
Work Phone:
UBC Student Number:
2.
Academic Information
Degree Program in 2009-2010:
Masters Program:
Doctoral Program:
UBC Department:
Year of Study:
How long is your program (i.e. For a two year program, write the number “2”)?
What program year are you currently enrolled in (i.e. For year one, write “1”)?
Will you be a full-time UBC graduate student (assessed full-time fees on Schedule A)* in 2010-2011?
Yes.
No. Please state your status:
3.
Academic History
University Attended:

Dates Attended:
(mm/yyyy – mm/yyyy)
Degree:
Part or Full-Time:
Students are automatically assessed full-time tuition (assessed on Schedule A) unless they have requested in writing to be
assessed part-time tuition (assessed on Schedule B).
Faculty of Graduate Studies, Awards
web: www.grad.ubc.ca/awards
180-6371 Crescent Road
e-mail: graduate.awards@ubc.ca
Vancouver, BC V6T 1Z2
phone: 604-822-2848
Canada
fax: 604-822-5802
2010-2011 Rick Hansen “Man in Motion” Fellowship Application Form
Page 1 of 6
Rick Hansen “Man in Motion” Fellowship Application Form
2010-2011 Competition
4.
Academic, Research, and Other Relevant Work Experience
Specify in first column whether employment was full- or part-time, and/or if you gained the experience in the
course of a program of study.
Position held and nature of work (begin with
current)
Organization and department
Faculty of Graduate Studies, Awards
180-6371 Crescent Road
Vancouver, BC V6T 1Z2
Canada
2010-2011 Rick Hansen “Man in Motion” Fellowship Application Form
Period
(mm/yyyy – mm/yyyy)
web: www.grad.ubc.ca/awards
e-mail: graduate.awards@ubc.ca
phone: 604-822-2848
fax: 604-822-5802
Page 2 of 6
Rick Hansen “Man in Motion” Fellowship Application Form
2010-2011 Competition
5.
Publications
Include the publication title, the journal (and whether it is refereed or not) and date of publication. Do not include
papers in progress.
6.
Presentations
List conferences attended and presentations given.
Faculty of Graduate Studies, Awards
180-6371 Crescent Road
Vancouver, BC V6T 1Z2
Canada
2010-2011 Rick Hansen “Man in Motion” Fellowship Application Form
web: www.grad.ubc.ca/awards
e-mail: graduate.awards@ubc.ca
phone: 604-822-2848
fax: 604-822-5802
Page 3 of 6
Rick Hansen “Man in Motion” Fellowship Application Form
2010-2011 Competition
7.
Additional Relevant Academic Information
List relevant work or volunteer experience, courses taken, etc.
8.
Exceptional Circumstances
Describe any interruptions or exceptional circumstances that affected your academic progress.
Faculty of Graduate Studies, Awards
180-6371 Crescent Road
Vancouver, BC V6T 1Z2
Canada
2010-2011 Rick Hansen “Man in Motion” Fellowship Application Form
web: www.grad.ubc.ca/awards
e-mail: graduate.awards@ubc.ca
phone: 604-822-2848
fax: 604-822-5802
Page 4 of 6
Rick Hansen “Man in Motion” Fellowship Application Form
2010-2011 Competition
9.
Outline of Proposed Research
In non-technical language, provide a detailed description of your proposed research project for the period during
which you are to hold the award. Be as specific as possible. State the objectives and outline the experimental or
theoretical approach to be taken (citing literature pertinent to the proposal), and the methods and procedures to
be used. (Do not exceed space provided below; do not attach any other documents.)
Faculty of Graduate Studies, Awards
180-6371 Crescent Road
Vancouver, BC V6T 1Z2
Canada
2010-2011 Rick Hansen “Man in Motion” Fellowship Application Form
web: www.grad.ubc.ca/awards
e-mail: graduate.awards@ubc.ca
phone: 604-822-2848
fax: 604-822-5802
Page 5 of 6
Rick Hansen “Man in Motion” Fellowship Application Form
2010-2011 Competition
10.
Awards and Scholarships History
Please provide a list of awards and scholarships you have held or currently hold. Please list the most recent
first, in descending chronological order.
Funding Agency
and Award Type:
Award Value:
Period Held (mm/yyyymm/yyyy):
Funding Agency
and Award Type:
Award Value:
Period Held (mm/yyyymm/yyyy):
Funding Agency
and Award Type:
Award Value:
Period Held (mm/yyyymm/yyyy):
Funding Agency
and Award Type:
Award Value:
Period Held (mm/yyyymm/yyyy):
Funding Agency
and Award Type:
Award Value:
Period Held (mm/yyyymm/yyyy):
11.
Referees
Please list the name and affiliation of the two referees from whom you have requested letters.
Referee 1:
Referee 2:
12.
Declaration
I understand the Dean of the Faculty of Graduate Studies reserves the right to revoke any award offer if any of
the information in this Application is found to be untrue or fraudulent.
Signature:
Faculty of Graduate Studies, Awards
180-6371 Crescent Road
Vancouver, BC V6T 1Z2
Canada
2010-2011 Rick Hansen “Man in Motion” Fellowship Application Form
Date:
web: www.grad.ubc.ca/awards
e-mail: graduate.awards@ubc.ca
phone: 604-822-2848
fax: 604-822-5802
Page 6 of 6