Application re: BHSc Research Practicum
(HLSC 4998U & 4999U) 2013 - 2014
To be completed by an undergraduate student.
Complete application form and submit as per instructions in ‘How to Apply’, no
later than 4:00pm on March 4, 2013. To fill out the form, double-click on the
highlighted areas and enter the text required.
Date:
Family name
My Campus email:
Given name
Initial(s)
Home Phone:
Cell Phone:
RESEARCH PRACTICUM PROJECT INFORMATION
Based on the Project Summaries viewed on the Faculty of Health Sciences website, rank your top three choices below.
Name of Research Tutor leading the project:
Title of project:
1.
2.
3.
UNDERGRADUATE ACADEMIC BACKGROUND (including current on-going post-secondary degree)
Expected Completion Date (mm/yr)
Name of Faculty/Specialization
At the time of the application, please specify if you are attending university:
Have you applied for a UOIT
undergraduate student research award
full-time
part-time
or Faculty of Health Sciences Research
Practicum before?
Yes
No
SCHOLARSHIPS AND OTHER AWARDS RECEIVED WHILE AT UNIVERSITY (Start with most recent)
Name of award
Brief description and value of the award
Period held
(yyyy/mm – yyyy/mm)
SIGNATURE
By checking this box:
I hereby agree to abide by UOIT’s policies and procedures governing research and scholarly
awards (www.research.uoit.ca).