CSS (PGY1-4) Application Form

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DEPARTMENT OF PSYCHIATRY University of Toronto APPLICATION FORM 2015-2016 Academic Year

Clinician Scientist Program

Centre for Addiction & Mental Health

250 College Street, Room 829 Toronto, Ontario M5T 1R8

http://www.psychiatry.utoronto.ca/research/clinician-scientist-program/

Complete all Sections. Please type or print clearly. Incomplete or illegible forms cannot be processed.

Legal Surname All legal given names in full (Indicate most commonly used 1. Program Applied For: CSS CSP 2. Former Surname 3. Sex 4. Date of Birth (yyyy/mm/dd) 5. Social Insurance Number 6. Present Mailing address Apt. # City No. & Street Province Country Area Code & Phone Number Postal Code 7. Permanent Address Apt. # City No. & Street Province Area Code & Phone Number Country Postal Code 8. Status in Canada Authorization 11. First Language 9. Country of Citizenship 12. Email Address 10. Marital Status

RESEARCH PROJECT

Include an overview (1-3 pages for CSS, 3 pages for CSP) of the proposed research project according to the guidelines below   Rationale/background: why is the topic important? What is known thus far?

Purpose, aims and hypotheses: what is the overarching goal of the research? How will it advance knowledge? What aspects are novel? What are the specific hypotheses to be tested?

 Methods: list specific aspects of study design including measures, timelines, sample characteristics, and overview of analytic approach. Has the data already been collected? *Will data be ready for analyses in time to ensure successful completion of CSP?  Methods: list specific aspects of study design including measures, timelines, sample characteristics, and overview of analytic approach. Has the data already been collected? *Will data be ready for analyses in time to ensure successful completion of CSP?  Environment: what resources and support are in place to assist the candidate? Who are the other members of the research team, in addition to the supervisor? What is the specific role of the candidate within the supervisor's program of research?

  Anticipated deliverables including first-author conference presentations and publications (be as specific as possible) Anticipated challenges to project and/or role of the student within project, and approach to these challenges

*Refers to CSP only

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