Application for Undergraduate Summer HEATER Fellowship

Application for Undergraduate Summer HEATER Fellowship

Section 1 – Applicant Information
Surname / Given Name / Student ID #
University / Program/Department/Faculty (e.g. Physics BSc.)
Email Address / Gender
Woman Man
Trans* / Date of Birth (dd/mm/yy)
Citizenship Status as of January 1, 2017:
Canadian Citizen / Permanent Resident / International Student
Current address / Permanent address (if different from current)
If current address is temporary, indicate leaving date:
Telephone number:
Section 2 – Training Information
At time of application, are you attending university: Full time Part time
Training Preference
Internship with University
Location Preference:
McMaster University
University of Waterloo
University of Toronto / Internship with Industry Partner - (CANMET, Hamilton)
Section 3 - Approvals
The undersigned agree to, and accept, the general conditions governing any award made pursuant to the sponsorship of this application, as set out in the NSERC CREATE grants and awards guidelines, located at as well as all the conditions specific to this CREATE program that are listed on the last page of this application.
PRIVACY NOTICE ‐NSERC requires Dr. Young-June Kim, CREATE Leader, to collect certain personal information from trainees, team members (co‐applicants and collaborators) and other individuals participating in the CREATE program. The purpose of gathering this information is to generate statistics that enables NSERC to report on the CREATE program’s overall performance. Only information that is needed will be requested of the applicants/supervisors. The personal information that is collected, used and disclosed is in accordance with the federal Privacy Act will be shared with the CREATE program committee. The personal information may also be shared with contractors hired to conduct data analysis, surveys or interviews on NSERC’s behalf.
______
Applicant’s Signature / ______
Date
Section 4 – Academic History
List ALL postsecondary institutions you have attended whether or not you received a degree from those institutions. In addition include your transcripts (unofficial copies are acceptable)
Degrees Completed or In Progress / Institution / Started (mm/yy) / Awarded/Expected
Section 5 – Scholarships, Awards and Bursaries
List all Scholarships, Awards, Bursaries, and/or other financial support you have received or applied for. Indicate if the award has not yet been offered.
Name of Award / Type / Start Date/Duration / Value

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