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.Onesigned PDF copy of the complete application. IMPORTANT: Upload your PDF to Sharefile here: . 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 studentship2015)

(b)Completion of application

Sections A-CE 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 Hmust 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 1stOR 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 .

Cystic Fibrosis Canada will acknowledge receipt of an application, via email, to the applicant by October 22nd.

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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 beemailed directly to Joanna Valsamis ()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 () 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 () 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 Canadamust 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: MSc PhD

Number of years support is requested: 1 2

DepartmentInstitution 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
___/___/___ / Acknowledged
___/___/___
Electronic copy
___/___/___ / Letter #1 / Letter #2 (initial)

07/2015

APPLICATION FOR A STUDENTSHIPPage 2

B. EDUCATIONAL BACKGROUND

Degrees held and/or expected

Transcripts included in the PDF and original copies appended to back of this application form.

DegreeStart dateEnd dateDiscipline Institution Supervisor (if applicable)

(mm/yyyy date format)

Research training

Please indicate any research or related experience. If not presently attending university, please indicate current employment.

Start date End date Institution/Employer Position Supervisor (if applicable)

(mm/yyyy date format)

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 STUDENTSHIPPage 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 STUDENTSHIPPage 4

Section Dshould 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 STUDENTSHIPPage 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 / Mailing Address / Date
FINANCIAL OFFICER
Title
Dr.Mr.Ms. / Given Name / Surname
Position
Institution / Street Address
City / Province / Postal Code
Telephone / Ext. / Fax / Email

APPLICATION FOR A STUDENTSHIPPage 6

H. PROPOSED SUPERVISOR

Section Hmust 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 appendedOR 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/sDate receivedDisciplineInstitution Supervisor (if applicable)

Research training (post-doctoral)

DatesInstitution Department Supervisor

Academic positions held and hospital appointments

DatesInstitution Department Position

Distinctions/awards

APPLICATION FOR A STUDENTSHIPPage 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.

NameProgram typeDatesDegreeYear degree received

(from/to)(received/expected)

Additional pages may be added, and should be inserted following this page.

Publications

Please indicate number of publications, as follows:TotalPast 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 STUDENTSHIPPage 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 Applied for
Principal Investigator:
Co-Investigator(s):
Granting Agency:
Title of Project:
Hours per week:
Period of support:
Amount: $
% Overlap with current application: