APPLICATION REQUIREMENTS FOR A RESEARCH STUDENTSHIP (October 2015)
(a)
Number of copies
One paper copy and one electronic copy of the complete application are required, as follows:
i.
One paper copy of the completed application form (with original signatures), plus the original copies of all required
academic transcripts. Transcripts must be appended to the back of the application form. The entire paper copy of the
application must be stapled in the upper, left-hand corner; do not clip individual sections of the application separately.
ii.
One signed PDF copy of the complete application.
IMPORTANT: Upload your PDF to Sharefile here:
https://cysticfibrosis.sharefile.com/r-r17ea70b788f484f8. The PDF must be a single file containing all sections of the
application form and all academic transcripts, appended pages, etc., in the correct order. Both sides of the transcripts,
front and back, must be copied in the PDF. Applicants must ensure that transcripts in the PDF are clear and legible. If
needed, combine multiple PDF files into a single file. The PDF must also have bookmarks to each individual section in the
application form (i.e. Sections A: General Information to H: Proposed Supervisor plus Academic Transcripts; create
bookmark links to go to these specific sections of the application). The file must be named as follows:
Surname_given name_CFC initial or renewal studentship 2015 (i.e. Smith_Jane_CFC initial studentship 2015)
(b)
Completion of application
Sections A-C & E of the application form must be completed by the applicant. Section D should be completed by
the supervisor if the applicant is working towards an M.Sc., and by the applicant if the applicant is working
towards a Ph.D. The applicant is responsible for obtaining the signatures required for Sections F-G. Section H
must be completed by the applicant's proposed supervisor.
(c)
Deadline for submissions
The deadline for receipt of an application is Thursday, October 1, 2015. Completed applications with all
supporting materials will be accepted only if hand-delivered to Cystic Fibrosis Canada’s office by 5:00 p.m. EDT
on October 1st OR courier-marked on/before midnight on the deadline day of October 1st. Applications sent by
courier must have guaranteed next-business day delivery. Incomplete and/or late applications will be
returned to the applicant.
Applications with supporting documentation must be sent to: Joanna Valsamis, Program Director, Research
Funding, Cystic Fibrosis Canada, 2323 Yonge Street, Suite 800, Toronto, ON, M4P 2C9, (416) 485-9149 x 230.
The letters of recommendation/letters-of-support must be emailed directly to jvalsamis@cysticfibrosis.ca.
Cystic Fibrosis Canada will acknowledge receipt of an application, via email, to the applicant by October 22nd.
07/2015
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(d)
Initial applications: supporting documentation
i. Two letters-of-recommendation by the referees, one of whom should be the applicant's current or most recent supervisor, must be
emailed directly to Joanna Valsamis (jvalsamis@cysticfibrosis.ca) and must arrive by the deadline.
ii. For joint MD/MSc or MD/PhD programs, a letter from their joint program director confirming enrollment in a joint program
and approval of the academic plan must be included with the original copy of the application form as well as in the PDF.
iii. Transcripts of the applicant's complete academic record from the issuing institution(s) must be included with the original copy
of the application form as well as in the PDF. In the case of individuals who pursued the Diplôme d'études collégiales at CEGEPs in
the province of Québec, transcripts must include the Bulletin cumulatif. Applicants are required to inform Cystic Fibrosis Canada of
any examination results received within two months following the submission deadline. These results may be submitted in the form
of a letter countersigned by the course instructors concerned.
(e)
Renewal applications: supporting documentation
Please note that a Cystic Fibrosis Canada Student currently receiving support for studies leading to a master's
degree who has transferred or who wishes to continue to a doctorate, must -- at the conclusion of the current
award -- reapply for an initial Cystic Fibrosis Canada Studentship at the doctoral level. Renewal at the master’s
level is not permitted.
i. A letter of support from the applicant's supervisor, describing the quality of the applicant's work to date and commenting on the
suitability of continued support, must be emailed directly to Joanna Valsamis (jvalsamis@cysticfibrosis.ca) and must arrive by the
deadline.
ii. Transcripts of the applicant's academic record since receiving his/her Cystic Fibrosis Canada Studentship, and from the issuing
institution(s), must be included with the original copy of the application form as well as in the PDF.
Please contact Joanna Valsamis, Program Director, Research Funding (jvalsamis@cysticfibrosis.ca) at Cystic
Fibrosis Canada’s office if you have any questions.
PLEASE REMOVE THESE TWO COVER PAGES PRIOR TO PRINTING AND SUBMITTING THE
APPLICATION FORM WITH ORIGINAL SIGNATURES AND CREATING A PDF COPY.
07/2015
APPLICATION FOR A STUDENTSHIP
Initial application
Renewal application
Sections A-C and E must be completed by the applicant.
A. GENERAL INFORMATION
Name of applicant
(Title, Given Name, Middle Name, Surname)
Mailing address
*Cystic Fibrosis Canada must be notified if the applicant's mailing address changes.*
Telephone
E-mail
Title of proposed research project
Proposed host institution
Studies for which Studentship support is requested:
Number of years support is requested:
Department
Institution
MSc
1
PhD
2
Commencement and Completion dates (mm/yyyy format)
Proposed supervisor’s name, host institution, department, full mailing address and e-mail:
For initial applicants, name and address of two references providing letters of recommendation. For renewal
applicants, only one letter-of-support from your supervisor is required.
1.
2.
FOR OFFICE USE ONLY
Hard copy
Entered
Entered
___/___/___
___/___/___
___/___/___
Electronic copy
Letter #1
___/___/___
Acknowledged
___/___/___
Letter #2 (initial)
07/2015
APPLICATION FOR A STUDENTSHIP
Page 2
B. EDUCATIONAL BACKGROUND
Degrees held and/or expected
Transcripts included in the PDF and original copies appended to back of this application form.
Degree
Start date
End date
(mm/yyyy date format)
Discipline
Institution
Supervisor (if applicable)
Research training
Please indicate any research or related experience. If not presently attending university, please indicate current
employment.
Start date End date
Institution/Employer
(mm/yyyy date format)
Position
Supervisor (if applicable)
Distinctions/awards
Please include all distinctions/awards, specifying dates held or received.
Start date (mm/yyyy)
End date (mm/yyyy)
Publications
Please provide a list, with full references, of any papers, abstracts, or theses written or published. Additional
pages may be used, and should be inserted following this page.
APPLICATION FOR A STUDENTSHIP
Page 3
C. CAREER GOALS
Provide a brief description of your career goals, and explain how a Cystic Fibrosis Canada Studentship would
help to advance these goals.
APPLICATION FOR A STUDENTSHIP
Page 4
Section D should be completed by the supervisor if the applicant is working towards an MSc,
and by the applicant if the applicant is working towards a PhD.
D. SUMMARY OF PROPOSED RESEARCH TRAINING
Title of applicant's research project
For initial applications, please provide a 1-page summary (single-sided, single-spaced, 1-inch margins on all
sides, in 12 point font size) of the research program you propose to undertake, and its relevance to cystic
fibrosis. A proposal is deemed to be relevant to cystic fibrosis and have an impact on CF patients if it is has a
high probability of achieving Cystic Fibrosis Canada’s mission to cure or control CF, or improve the health
and/or quality of life for people with CF.
For renewal applications, please provide a 1-page report (single-sided, single-spaced, 1-inch margins on all
sides, in 12 point font size) summarizing your progress during the tenure of your Cystic Fibrosis Canada
Studentship to date, outlining the work you propose to undertake if a renewal is granted and its relevance to
cystic fibrosis . A proposal is deemed to be relevant to cystic fibrosis and have an impact on CF patients if it is
has a high probability of achieving Cystic Fibrosis Canada’s mission to cure or control CF, or improve the health
and/or quality of life for people with CF.
For joint MD/MSc or MD/PhD programs, please attach an additional page describing the impact of the proposed
research training program on your academic plan and detailing how the program will be structured (i.e. when
the research will be done, percentage of time spent on research at each stage of the program, etc.).
Please type your summary on a separate page. Insert the summary page, and impact statement if appropriate
(only applicable for MD/MSc or MD/PhD applicants), following this page. References should be included
following the 1-page summary, and impact statement if appropriate. Please note that references are excluded
from the 1-page limit. In addition, please note that figures/tables/charts are not permitted.
Cystic Fibrosis Canada places a high priority on ensuring that funded research addresses the organization’s mission and our Core
Principles of funding the best science that has the highest probability of making an impact for CF patients.
E. UNDERTAKING OF APPLICANT
The undersigned hereby agrees that the conditions governing the award of a Studentship, as detailed in Cystic
Fibrosis Canada’s Grants & Awards Guide, apply to any grant awarded under this application, and that these
conditions are accepted by the applicant.
Signature of applicant ________________________ Date
The applicant is responsible for obtaining the signatures required for Sections E-F.
F. UNDERTAKING OF SUPERVISOR
I endorse the research training program proposed by the applicant. If an award is granted, I agree to accept
the Student for research training in my laboratory, and certify that adequate resources will be available to
cover the costs of the Student's research.
Proposed Supervisor
Name
Signature
Date
APPLICATION FOR A STUDENTSHIP
Page 5
G. UNDERTAKING OF INSTITUTION
The undersigned hereby agree that the conditions governing the award of a Studentship, as detailed in Cystic
Fibrosis Canada’s Grants & Awards Guide, apply to any grant awarded under this application, and that these
conditions are accepted by this institution.
Head of Department or Dean of Faculty
Name
Signature
Mailing Address
Date
Executive Authority of Host Institution (within which the research will be conducted and funds
administered)
Name
Signature
FINANCIAL OFFICER
Title
Dr.
Mr.
Given Name
Mailing Address
Date
Surname
Ms.
Position
Institution
Street Address
City
Telephone
Province
Ext.
Fax
Email
Postal Code
APPLICATION FOR A STUDENTSHIP
Page 6
H. PROPOSED SUPERVISOR
Section H must be completed by the applicant’s proposed supervisor OR the CV module from a Cystic Fibrosis
Canada research grant application (Sections D and E) may be appended OR a current curriculum vitae, which
includes sources of funding and the number of publications from the last five years, may be attached in place of
Section H.
Name
Title, Given Name, Middle Initial, Surname
Place of birth
City, Province/State, Country
Education
Degree/s
Date received Discipline
Institution
Supervisor (if applicable)
Research training (post-doctoral)
Dates
Institution
Department
Supervisor
Academic positions held and hospital appointments
Dates
Distinctions/awards
Institution
Department
Position
APPLICATION FOR A STUDENTSHIP
Page 7
H. PROPOSED SUPERVISOR (cont'd.)
Supervisory experience
Please list the trainees that you have supervised/co-supervised (and are currently
supervising/co-supervising) within the last five (5) years.
Name
Program type
Dates
(from/to)
Degree
(received/expected)
Year degree received
Additional pages may be added, and should be inserted following this page.
Publications
Please indicate number of publications, as follows:
Total
Past five years
Refereed papers, published
Refereed papers, accepted/in press
Refereed papers, submitted
Book chapters, published or in press
Abstracts
Patents held or pending, including software
Please provide full references for all publications from the past five years only, subdivided into the above
categories and indicate those publications which cite Cystic Fibrosis Canada support. Additional pages may be
added, and should be inserted following this page.
APPLICATION FOR A STUDENTSHIP
Page 8
H. PROPOSED SUPERVISOR (cont'd.)
Sources of funding
Please list all sources of active support and/or funds applied for, and describe the degree of overlap with this
application. If the proposed supervisor holds, or holds and has applied for, more than three grants, additional
pages should be attached following this page.
GRANT #
Currently held
Applied for
Principal Investigator:
Co-Investigator(s):
Granting Agency:
Title of Project:
Hours per week:
Period of support:
Amount:
$
% Overlap with current application:
GRANT #
Currently held
Applied for
Principal Investigator:
Co-Investigator(s):
Granting Agency:
Title of Project:
Hours per week:
Period of support:
Amount:
$
% Overlap with current application:
GRANT #
Currently held
Principal Investigator:
Co-Investigator(s):
Granting Agency:
Title of Project:
Hours per week:
Period of support:
Amount:
$
% Overlap with current application:
Applied for