nderstanding Canada – Canadian Studies
APPLICATION FORM: DOCTORAL STUDENT RESEARCH AWARD
SECTION A: PERSONAL INFORMATION
(DSRA)
1. Full Name:
LAST NAME, First Name (Title)
2. Gender :
F
M
3. Addresses:
Home
Educational Institution
Telephone:
E-mail:
Telephone:
E-mail:
Communications about an award should be sent to: Home 
Educational Institution 
4. Nationality and/or Citizenship:
Please attach a certified copy of birth certificate, citizenship card, or record of landing, whichever is
applicable (DO NOT FORWARD ORIGINAL). (A “certified copy” is a photocopy of the original
document certified as being a true copy by a competent authority (that is, signed by a lawyer, medical
doctor, justice of peace, university administration, etc.).
5. a) Academic Qualifications:
b) Discipline and/or department within institution:
c) Please attach transcripts of graduate studies to date.
6. Language Abilities*:
Oral
Written
English
French




* Please indicate proficiency with corresponding letters: Excellent, Good, Fair or Nil.
7. Please provide a brief statement outlining your background field(s) of specialty and particular areas of
interest in Canadian Studies.
8. Please attach copies of your curriculum vitae, including the list of your publications.
DSRA APPLICATION FORM: page 1 of 4
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SECTION B: RESEARCH PROPOSAL
(DSRA)
1. Discipline in which research is to be undertaken:
2. Research topic/title:
3. Please attach your dissertation prospectus as approved by your dissertation committee and/or your
sponsor/director/advisor. It should identify the key issues or the main theoretical problem, justify the
appropriate methodology, and indicate clearly both the nature and the scope of the dissertation’s
contribution to the field of specialization as well as the advancement of Canadian studies.
4. Summary of attached dissertation prospectus (not more than 100 words).
SECTION C: REFERENCES
(DSRA)
Names and addresses of two academics, one of who must be the dissertation sponsor/advisor, who have
been asked to submit letters of recommendation on your behalf direct to the Canadian Mission by the
deadline set for the competition. The Canadian Mission will not follow up on your letters of reference.
Letters of recommendation should testify to the ability of the applicant to complete successfully the
dissertation within a reasonable length of time; the suitability of the research proposal as a contribution to
the general body of literature in the field chosen; and its contribution to the advancement of Canadian
Studies, particularly in the applicant’s country of residence.
Note: These recommendations are essential to the evaluation committee. It is the responsibility of
the applicant to ensure that they are received on time. Referees may be contacted by the
Canadian Embassy for additional comment, if necessary.
1)
DSRA APPLICATION FORM: page 2 of 4
2)
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SECTION D: RESEARCH PROGRAM IN CANADA
AND FUNDING SOURCES
(DSRA)
1. Please explain clearly the present status of your doctoral studies and describe your study plans in
Canada, including contacts such as scholars, research institutes, academic institutions or
libraries/archives (Attach additional sheet if needed):
2. Anticipated date of departure:
, date of return:
D/M/Y
D/M/Y
3. Grant calculation
International airfare:
Allowance for living expenses and domestic travel:
months x $1,200 Cdn (maximum 6 months) =
TOTAL:
4. Please provide information on potential and actual known sources of other funding (if any) for this
research proposal:
DSRA APPLICATION FORM: page 3 of 4
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SECTION E: ACCEPTANCE OF AND COMPLIANCE TO
THE CONDITIONS OF AWARD
I confirm that I,
(DSRA)
, am a graduate student at:
(Name, printed)
(Name of recognized degree-granting institution of higher education)
If I am granted an award for the Canadian Studies research purposes described in this application, I
agree:
a) to make all the necessary arrangements relating to the research project;
b) to carry out the proposed research, for which I am personally responsible, and which is
a part of my formal program of studies leading to a doctoral degree;
c) to reside in Canada throughout the period to which the award relates;
d) to advise promptly the Canadian Mission and/or the Department of Foreign Affairs and
International Trade Canada (Ottawa), should I drop out of my doctoral program;
e) to provide a report of research activities and progress while in Canada within two
months of returning to my country;
f) to provide two copies of the dissertation when completed.
I understand that medical insurance coverage while in Canada is my personal responsibility.
_______________________________________
Signature of Applicant
_____________________________________
Date
DSRA APPLICATION FORM: page 4 of 4