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Prism Graduate Student

Scholarship Application Form

Submission Deadline: June 30, 2016

1. APPLICANT INFORMATION:
SURNAME / GIVEN NAME / DEPARTMENT(S)
LOCATION / TELEPHONE NUMBER / FAX NUMBER
SIGNATURE / DATE / EMAIL
2. SUPERVISOR ONE INFORMATION:
SURNAME / GIVEN NAME / DEPARTMENT
LOCATION / TELEPHONE NUMBER / FAX NUMBER
SIGNATURE / DATE / EMAIL
3. SUPERVISOR TWO (or close Collaborator) INFORMATION:
SURNAME / GIVEN NAME / DEPARTMENT
LOCATION / TELEPHONE NUMBER / FAX NUMBER
SIGNATURE / DATE / EMAIL

4. PROJECT INFORMATION:

PROJECT TITLE:
GRADUATE STUDENT PROGRAM:
M.Sc Currently in M.Sc. program, but will transfer to Ph.D. within the next year Ph.D.
DATE FIRST STARTED (OR PROPOSED) IN CURRENT GRADUATE PROGRAM:

5.Applicant’s Academic Training

Degree / Discipline / Department, Institution.
Country / Date Started
(mm/yyyy) / Date Completed or Expected
(mm/yyyy)
Bachelor
Masters
Ph.D.
Other, specify

6.Applicant’s Academic Honours and Awards:

List undergraduate honours and awards, indicating type and dates.

7.Scholarships Currently Held or Applied For by the Applicant:

Type of Award / Agency / Total Amount
of Award / Start Date
(mm/yyyy) / End Date
(mm/yyyy) / Applied for or Awarded

8.Applicant’s Publication Record(List all publications published or accepted. Do not include manuscripts in preparation or submitted. List conference abstracts separately. Use additional pages as required):

9. Detailed Project Description

Using 1 full page only, provide a description of the proposed research project to be carried out. Be sure to focus on the collaborative nature of the project and how this project enables the two co-supervisors (or supervisor and close collaborator) to further their cooperative research into the study of proteins (this descriptive text may be deleted).

TO BE COMPLETED BY SUPERVISOR ONE

10.Supervisor’s Research Funding Support

List current grant support held and applied for. List title of grant, agency, amount awarded/requested and period of grant.

11.Publication Record of Supervisor:

List publications over the past 5 years. Only include those published or accepted for publication. List conference abstracts separately. Use additional pages as required.

TO BE COMPLETED BY SUPERVISOR TWO, OR CLOSE COLLABORATOR
10.Supervisor’s/Collaborator’s Research Funding Support
List current grant support held and applied for. List title of grant, agency, amount awarded/requested and period of grant.
11.Publication Record of Supervisor/Collaborator:
List publications over the past 5 years. Only include those published or accepted for publication. List conference abstracts separately. Use additional pages as required.

12. SUPERVISOR’S MATCHING FUNDING INFORMATION:

If successful, the funding term is for two years beginning September 1 in the year of application (OR less if the student graduates).
The PRISM Scholarship is for $10,000 per year with the remaining matching funds ($5,000 minimum each) from each of two PRISM members, either as co-supervisors of the student, or supervisor and close collaborator.
PROVIDE ADDITIONAL FUND NUMBERS FROM WHICH THE MATCHING FUNDS WILL BE PAID (e.g. operating grant):
Supervisor One (Name): ______FUND NUMBER ______
Supervisor Two (Name): ______FUND NUMBER ______
(OR close Collaborator)

13. TRANSCRIPTS:

Applicants must include a copy of all transcripts from post-secondary education, including undergraduate and graduate study, as applicable. An unofficial PAWS copy for local transcripts is fine. All transcripts should be scanned and attached to this application.

Please ensure that all sections of this application are complete.

INCOMPLETE AND LATE SUBMISSIONS OF APPLICATIONS WILL NOT BE ACCEPTED.

Please provide the following by June 30, 2016:

  • 1 ELECTRONIC COPY of the application containingall transcripts and signatures, as one pdf file, should be emailed to

Contact phone number: 306-966-1417

PRISM Scholarship Application – 2016Page 1