UTISM ESEARCH RAINING Program APPLICATION FORM Application Guidelines and Process 2015 Dear Applicant, Thank you for inquiring about the Autism Research Training (ART) Program. The ART Program is funded by the Canadian Institutes of Health Research (CIHR), through the Strategic Training Initiative in Health Research (STIHR), with additional funding the Sinneave Family Foundation, McGill University, and other in-kind Canadian university contributions. The training program goal is to recruit and train outstanding researchers in the field of autism, in disciplines such as genetics, brain imaging, epidemiology, neurology, psychiatry, psychology and others. Upon completing the program, trainees will be equipped with a broad interdisciplinary knowledge base, a rich repertoire of research skills, strong connections to a vigorous research community in special populations, and an ability to translate research into practice. The program is organized around two central sites, McGill University and University of Alberta, which coordinates activities with 16 other universities, and 38 faculty members from across Canada. Over the past decade, ART has had a significant impact in building ASD research capacity nationally, fostering the development of a new generation of ASD scientists with transdisciplinary training, ready to tackle complex issues of importance to families, policy makers and other stakeholders. ART Program training activities include participation to a 5-day intensive Summer School Program, a biennial Winter Institute, an international guest speaker event at IMFAR, and knowledge translation and dissemination activities. Trainees receive mentorship from 3 ART faculty members – facilitated by emails, phone calls, faceto-face meetings. ELIGIBILITY CRITERIA The Program is open to health professionals, doctoral students, post-doctoral fellows and clinical fellows with a solid academic disciplinary background in health care, science, social sciences, or humanities. Trainees are selected based on outstanding academic profiles; commitment to a research career; and the strength, transdisciplinarity and relevance of their research proposals. Applicants must be registered at a Canadian university by September 2015, where they complete their core training and conduct their research at their supervisor’s facility. While candidates must demonstrate support from at least one ART program mentor with their application, it is not mandatory that the trainee’s main supervisor be an ART mentor. FUNDING OPPORTUNITIES Candidates admitted for the year 2015-16 will: attend Summer School in August 2015 (travel, food & accommodation paid for by ART Program); attend Winter Institute in March 2016 (travel, food & accommodation paid for by ART Program); be eligible to a $1,250 travel allowance to attend conferences such as IMFAR and/or visit their mentor’s lab; receive mentorship from 3 ART mentors over a 1-yr period. Note: Because of the changes to the funding supports available to the ART Program, we are not able to offer a student stipend to candidates admitted to the ART Program following this competition. APPLICATION DEADLINE: March 6, 2015, midnight Eastern Time All application documents must be received by the application deadline. Applications are not based on financial need. Criteria for ranking applicants will include: (a) research area in autism; (b) positive letters from supervisors; (c) support by ART Faculty Member; (d) record showing academic excellence and research productivity. ALL APPLICATIONS MUST INCLUDE: 1) ART Program Application Form. Please use Times New Roman font size 11. Including a detailed summary of your proposed research project (4 pages max, within the Application Form). Provide a brief introduction to the issue. Provide a context for the research question that you will address. Describe the sample, procedures, analyses, expected results and the implications of those results for theory or practice. 2) Curriculum Vitae (must include, but not restricted to, the categories below) a) Education: Provide the institution name and all degrees obtained including years, starting with most recent degree. b) Research/Clinical Experience c) Personal funding support (i.e. fellowship, teaching/research assistantship, scholarship, bursary, stipend) d) Research Funding received (Specify total amount received and source of funding) e) Publications 3) A copy of your academic transcripts and license a) Official undergraduate/graduate transcripts (transcripts must be sealed) b) A copy of your professional license, if applicable. 4) Three (3) letters of recommendation a) From individuals familiar with your work, preferably in your area of specialization. One letter of recommendation must be from an ART Faculty member. b) Provide each of your referees with the Reference Letter Form and a return envelope. c) Letters of recommendations should be mailed or emailed directly from the referee to the ART Program Advisory Committee (see address below). Applicant must email – 1), and 2) to: ART Program Advisory Committee melanie.viau@muhc.mcgill.ca University must mail – 3) to: ART Program Advisory Committee c/o: Mélanie Viau, Program Coordinator Montreal Children’s Hospital 4018 Ste-Catherine Street West, Rm. K-205A Montréal, Québec, H3Z 1P2, Canada Referees must mail or email – 4) to: see address and email above Applicant Data For Correspondence: Mr. Ms. Family Name Given Name Gender: DOB: yyyy-MM-dd Citizenship: Dr. Canadian Male Female Social Insurance Number (If Canadian Resident) Permanent Resident Student Visa Other (Specify) Country of Citizenship: Nationality: Mother Tongue: Principal Language Used: English French Mailing Address (To be used on all correspondence concerning your application) Street number, Street Name, Apt.#. City Province/State Postal/Zip Code Country Contact Information (To be used on all correspondence concerning your application) Home Telephone Number Work Telephone Number Mobile Telephone Number (ex. 514-555-0123) Fax Number E – mail Education Information Highest Degree completed: Choose Discipline: Choose Year completed: Choose Present Status: Choose Discipline: Choose Year completion expected: Choose Research & Career Objectives 1. Chronologically (from most recent) list any research experience you have acquired. Project Institution/Company Director/ Co-Director(s) Ex. Pathways in ASD McGill University Dr. E. Fombonne From (mo/yr) – To (mo/yr) 01/06 – 01/09 2. What are your general career objectives? 3. What specific knowledge and skills do you hope to acquire during your Autism Research Training? 4. How will the knowledge and skills you acquire during the ART Program help you attain your career objectives? 5. What particular area (s) of autism research would you like to focus on during your training program? Summary of Curriculum vitae University Education (including current degree) – please enclose official transcripts Institution – Country Ex. McGill-Canada Discipline Educational Psychology From (mo/yr – mo/yr) 01/89 –05/91 Diploma MA Funding Funds REQUESTED: List all research support currently applied for from all sources (e.g. industry, academic...) Funding Source / Organization Ex. FRSQ Project Name The Gene-A Trial Amount applied $250,0000 From (mo/yr) 01/05 To (mo/yr) 01/09 Funds CURRENTLY HELD: List all research support currently held from all sources (e.g. industry, academic…) Funding Source / Organization Ex. SSHERC Project Name Prevalence of Autism Amount $250,0000 From (mo/yr) 01/04 To (mo/yr) 01/05 Funds HELD IN THE LAST FIVE YEARS: List all research support held in the last five years and now terminated from all sources (e.g. industry, academic...) Funding Source / Organization Ex. McGill University Scholarship Project Name Depression in Graduate students Amount $5,000 From (mo/yr) 09/00 To (mo/yr) 09/01 Publications /Presentations Please record the total number of presentations/publications (published/accepted and/or in press) for the years 2013 and 2014. A list of all publications should be included in your curriculum vitae. Total # 1. Total number of peer reviewed publications? 2. How many of the above were published in one of the top five journals in your field of discipline? 3. How many other reports and/or publications were published with you as an author? 4. How many conference presentations were presented with you as an author? Program Supervisor All trainees should have a designated member of their respective university to monitor the trainee’s progress throughout the graduate program, to ensure that all conditions of admission and requirements are fulfilled, to provide students with information on their program, their progress through it, sources of and policies on financial support and to advise them how to resolve problems which may arise during their program. A Program Supervisor is your thesis/project supervisor from your department/university. Name & address of proposed Program Supervisor: Name: Address: Number of graduate & postdoctoral trainees in the laboratory of the project supervisor: Number of graduate students Number of postgraduates Specify the title of the research project of each of these individuals. ART Program Mentors The ART Program consists of 38 Faculty who will act as mentors for trainees enrolled in the ART Program. The mentors will work closely with the trainee and provide guidance and supervision during their time in the program. Over the course of the trainee’s ART Program, a rotation at each of the 3 mentor’s facilities will be facilitated with travel funding. At least once a year the mentors and trainees will meet to evaluate the trainee’s progress. From the ART Program Faculty list below, please select 3 you would like to have as mentors. By selecting the mentor you are also selecting the disciplines / areas of research in which you would like to be trained. Your Program Supervisor cannot be one of your mentors. One mentor should be from your field of study, and the other 2 should represent complementary disciplines and expertise (eg. A graduate student in the Department of Educational Psychology at McGill, whose Program Supervisor is Dr. Burack, might choose Dr. Mirenda as the mentor in his / her area of specialty, and then may want to be mentored in disciplines such as psychiatry and developmental pediatrics and choose Drs. Bailey and Roberts as his / her 2 other mentors). 1-Evdokia Anagnostou UToronto – Clinical Trials / Neuroimaging / Neurology 2-Anthony Bailey UBC – Genetics / Neuroimaging / Psychiatry 3-Armando Bertone McGill – Visual Perception 4-Michael Boyle McMaster – Epidemiology / Statistical Methods 5-Jessica Brian UToronto – Early Detection / Intervention 6-Susan Bryson Dalhousie – Developmental Neuropsychology / Early Detection / Intervention 7-Jacob A. Burack McGill – Educational Psychology / Neuropsychology 8-Melanie Couture USherbrooke – Occupational Therapy 9-Mayada Elsabbagh McGill – Brain Development / Knowledge Translation 10-James Enns UBC – Neuroscience / Psychology 11-Alan Evans McGill – Neuroimaging 12-Margaret Fahnestock McMaster – Neurochemistry 13-Krista Hyde UMontreal – Developmental neurobiology / Neuropsychology 14-Grace Iarocci SFU – Psychology 15-Shannon Johnson Dalhousie – Neuropsychology / Psychology 16-Elizabeth Kelley Queens – Neuropsychology / Psychology 17-Tara Kennedy New-Brunswick – Knowledge Transfer / Medical Education / Paediatrics / Qualitative Research Methods 18-Alan Kingstone UBC – Neuroscience 19-Pat Mirenda UBC – Educational Psychology / Intervention 20-Chris Moore Dalhousie – Psychology 21-Laurent Mottron UMontreal – Neuropsychology 22-Gina Muckle ULaval – Neurobehavioral Teratology 23-Aparna Nadig McGill – psycholinguistics and social cognition 24-David Nicholas UCalgary – Family Experiences / Knowledge Transfer / Social Work 25-Rob Nicholson UWO – Neuroimaging 26-Andrew Paterson UToronto – Genetics 27-Wendy Roberts UToronto – Developmental Paediatrics / Early Detection / Genetics / Intervention 28-Mel Rutherford McMaster - Social perception / Early detection 29-Steve Scherer UToronto – Genetics and Genomics 30-Isabel Smith Dalhousie – Clinical / Developmental Psychology 31-Veronica Smith UAlberta – Educational Psychology / Intervention / Speech-Language Pathology 32-Peter Szatmari UToronto – Classification / Diagnosis / Genetics / Outcome Studies / Psychiatry 33-Jim Tanaka UVictoria – Intervention / Neuroscience / Psychology 34-Tracy Vaillancourt UOttawa – Statistical Methods 35-Joanne Volden UAlberta – Speech Language Pathology 36-Jonathan Weiss York - Psychology / Intervention / Family Experience 37-Rosanna Weksberg UToronto – Epigenetics 38-Lonnie Zwaigenbaum UAlberta – Early Detection / Paediatrics Names of proposed ART Program Mentors you would like to train with and why? Please indicate if you have already worked or have been in communication with the named mentors. Mentor 1. Mentor 2. Mentor 3. Reference Letters Please supply names and addresses of 3 referees of whom you will be requesting letters to be forwarded to the Committee. Please provide each of your referees with the Reference Letter Form provided with this application. Reference Letters need to be mailed or emailed separately from the application and must come directly from the Referee. One of these referees must be an ART Faculty Member. 1. Name: Relationship: Contact Information: 2. Name: Relationship: Contact Information: 3. Name: Relationship: Contact Information: Description of proposed research Level: Masters PhD Postdoctoral Other (Specify) Start date: In which laboratory (ies) will the project take place? Name of Institution Name of Lab/Clinic Ex. Montreal Children’s Hospital ASD Clinic Name of Director Dr. E. Fombonne Name of Co-Directors Dr. L. Tidmarsh Describe the respective contribution of research director, co-director and collaborator(s) to your project. Will there be anyone else (graduate/undergraduate student), from your lab working with you on your project? No Yes Name of Teammate: Discipline: Describe your teammate’s contribution to your project. What aspect(s) of the project has already been funded? Please indicate the source of funding, name of the funded individual and the amount of funding. Description of proposed research Give a clear description of the objective of a research project you would like to work on during your training. Include relevant background material. Discuss the significance of the work and its relationship to autism. In order to enable the Program Advisory Committee to appreciate your proposed research project properly, provide sufficient details. This section must not exceed four (4) pages. Title of Research Project (brief but descriptive): Description of proposed research* *=Please note: Copy and use this page up to two (2) additional times UTISM ESEARCH RAINING Program REFERENCE LETTER Referee # 1 Note to the Referee: The information you provide is essential to the ART Program Selection Committee in evaluating the suitability of the applicant for support. Therefore, you are asked to give detailed information (both positive and negative) about the applicant. You may do so in an accompanying letter. Name of Applicant: Referee Name: Position/Dept./Institution: Indicate the period of time and in what capacity you have known the applicant. You may attach a letter, as desired. Please elaborate on the applicant’s performance during his/her clinical and or research training, as well as your assessment of the applicant’s potential to perform in a research setting. You may attach a letter as desired. In your overall assessment would you please indicate the applicant’s merit relative to others with the same level of training: Exceptional (top 5%) Excellent (top 10%) Your assessment should be mailed or emailed directly to: Very Good (top 20%) Good (top 30%) Acceptable (Below 30%) ART Program Advisory Committee c/o: Mélanie Viau, Program Coordinator Montreal Children’s Hospital 4018 Ste-Catherine Street West, Rm. K-205A Montréal, Québec, H3Z 1P2, Canada melanie.viau@muhc.mcgill.ca Thank you for your advice and assistance in this decision-making process. UTISM ESEARCH RAINING Program REFERENCE LETTER Referee # 2 Note to the Referee: The information you provide is essential to the ART Program Selection Committee in evaluating the suitability of the applicant for support. Therefore, you are asked to give detailed information (both positive and negative) about the applicant. You may do so in an accompanying letter. Name of Applicant: Referee Name: Position/Dept./Institution: Indicate the period of time and in what capacity you have known the applicant. You may attach a letter, as desired. Please elaborate on the applicant’s performance during his/her clinical and or research training, as well as your assessment of the applicant’s potential to perform in a research setting. You may attach a letter as desired. In your overall assessment would you please indicate the applicant’s merit relative to others with the same level of training: Exceptional (top 5%) Excellent (top 10%) Your assessment should be mailed or emailed directly to: Very Good (top 20%) Good (top 30%) Acceptable (Below 30%) ART Program Advisory Committee c/o: Mélanie Viau, Program Coordinator Montreal Children’s Hospital 4018 Ste-Catherine Street West, Rm. K-205A Montréal, Québec, H3Z 1P2, Canada melanie.viau@muhc.mcgill.ca Thank you for your advice and assistance in this decision-making process. UTISM ESEARCH RAINING Program REFERENCE LETTER Referee # 3 Note to the Referee: The information you provide is essential to the ART Program Selection Committee in evaluating the suitability of the applicant for support. Therefore, you are asked to give detailed information (both positive and negative) about the applicant. You may do so in an accompanying letter. Name of Applicant: Referee Name: Position/Dept./Institution: Indicate the period of time and in what capacity you have known the applicant. You may attach a letter, as desired. Please elaborate on the applicant’s performance during his/her clinical and or research training, as well as your assessment of the applicant’s potential to perform in a research setting. You may attach a letter as desired. In your overall assessment would you please indicate the applicant’s merit relative to others with the same level of training: Exceptional (top 5%) Excellent (top 10%) Your assessment should be mailed or emailed directly to: Very Good (top 20%) Good (top 30%) Acceptable (Below 30%) ART Program Advisory Committee c/o: Mélanie Viau, Program Coordinator Montreal Children’s Hospital 4018 Ste-Catherine Street West, Rm. K-205A Montréal, Québec, H3Z 1P2, Canada melanie.viau@muhc.mcgill.ca Thank you for your advice and assistance in this decision-making process.