ELAP 2015-2016 MS Word Template for UM Faculty Members
Instruction for UM Supervisors
Please use the following Microsoft Word document to upload your application responses. The
International Office is required to upload these responses as the institutional representative to
CBIE. Please contact Helen Balderama, International Office if you have any questions.
Application Questions (as written on the DFATD/ELAP Website)
Canadian institutions must apply on behalf of the candidate. They must complete the online
application form with all supporting documents submitted with this form prior to the
deadline.
APPLICATION FORM TO BE COMPLETED BY THE PERSON RESPONSIBLE FOR THE
SCHOLARSHIP PROGRAMS AT THE CANADIAN INSTITUTION.
(*) - Mandatory/required fields
1. PROGRAM
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Program* [Undergraduate/Graduate]
2. CANADIAN ACADEMIC SUPERVISOR
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Salutation (Mr/Ms/Dr/Prof)*
First Name
Last Name*
Institution*
Job Title*
Department/Office*
Address*
City*
Province*
Postal Code*
Phone*
Fax*
Email*
3. CONTACT PERSON RESPONSIBLE FOR THE PROGRAM AT
CANDIDATE'S HOME INSTITUTION
Ms. Helen Balderama
University of Manitoba International Office
536A University Centre, Winnipeg
Manitoba R3T 2N2
Phone: 204-474-7374; Fax: 204-474-7648
Email: Helen.Balderama@umanitoba.ca
Language of Correspondence: English
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ELAP 2015-2016 MS Word Template for UM Faculty Members
4. CONTACT PERSON RESPONSIBLE FOR THE PROGRAM AT
CANDIDATE'S HOME INSTITUTION
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Salutation (Mr/Ms/Dr/Prof)*
First Name*
Last Name*
Job Title*
Institution*
Department/Office*
Address*
City*
Province/State/Region*
Postal Code/ZIP*
Country*
Email*
5. CANDIDATE INFORMATION
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Salutation (Mr/Ms/Dr/Prof)*
First Name*
Last Name*
Gender*
Email*
Country of Citizenship*
Degree Sought at Home Institution*
Degree Sought at Home Institution*
Field of Study*
Discipline*
Expected Completion Date of Degree (mm/yyyy) *
Job Title at Home Institution*
Employed at Home Institution Since (mm/yyyy) *
6. SUMMARY OF STUDY PROGRAM/RESEARCH
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Title of research and/or study program*
Provide a Summary of the Research Project or Courses to be undertaken (maximum
1000 characters)*
 For College and Undergraduate students: please provide a list of courses the student
will be taking in Canada
 FOR GRADUATE STUDENTS: Please include the Research Project Summary stated in
this form in the UM Letter of Support
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Expected Start Date of Scholarship (dd/mm/yyyy) *
Expected End Date of Scholarship (dd/mm/yyyy)*
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ELAP 2015-2016 MS Word Template for UM Faculty Members
7. HISTORY OF INTER-INSTITUTIONAL COLLABORATION
Please describe the nature of the agreement i.e., formal Memorandum of Understanding,
informal agreement between post-secondary institutions or departments, research
collaboration between professors, etc. (maximum 1000 characters)*
8. DECLARATION AND PERMISSION
I have checked this application and its supporting documents and certify that all statements
contained within it are correct to the best of my knowledge. I will notify the CBIE should
there be any changes in the information provided in this application. I give CBIE permission
to verify the information I have presented in this application and in all supporting
documents. I agree that funding obtained will only be used for student expenses and that no
administrative expenses, other than the $300 administration fee, will be covered by this
scholarship.
By checking this box, I acknowledge that I have read this statement and agree to its
conditions. *
9. REQUIRED SUPPORTING DOCUMENTS
IMPORTANT NOTE:
UPLOADED DOCUMENTS MUST BE LESS THAN 5 MB and meet accepted formats: jpg, gif, doc, pdf,
doc, docx, txt. Uploaded documents over 5 MB will result in loss of your application data.
REQUIRED ATTACHMENTS (.jpg, .gif, .doc, .pdf, .docx, .txt, <5MB)
 Letter of intent from candidate.*
 Privacy Notice Statement signed by the candidate* download doc Privacy Notice
Statement for non-Canadian participants
 Proof of citizenship.*
 Proof of full-time enrollment.*
 Letter of support from home institution.*
 Signed copy of Memorandum of Understanding or Agreement with the partner
institution.* [Required only for Undergraduate Students]
 Letter of invitation from Canadian supervisor (for graduate candidates only).*
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