Application for Izaak Walton Killam Postdoctoral Fellowship
· Application must be word-processed or typewritten
Family Name:Given Names:
Nationality: / Citizenship:
Gender: / Male / Female
Mailing Address:
Permanent Address
(If different from above):
Home Telephone (include country & city code):
Office Telephone (include country & city code):
Facsimile (include country & city code):
Email:
Are you currently, or have you ever been, employed/paid by Dalhousie? / Yes / No
Have you physically been at Dalhousie or King’s at any time since the beginning of the academic year (September 1) and been funded independently of the Dalhousie or King’s payroll offices? / Yes / No
Indicate Extent of English Language Knowledge:
Written: / Excellent / Good / Poor
Read: / Excellent / Good / Poor
Oral: / Excellent / Good / Poor
Name of Department in which you wish to work:
Name of person you wish to work with at Dalhousie:
If granted, date you would like to take up award (between May 1st and January 15th):
Numbers in the following sections correspond with those found in the Izaak Walton Killam Postdoctoral Fellowship Competition Guidelines (see “Application Instructions”).
1. Degrees or Diplomas:Degree / Programme / University / Month/Year
If applicable, you are invited to attach a statement (maximum one (1) page) explaining interruptions in study or extenuating circumstances that impacted on your academic records. / Statement Attached?
Yes / No
2. Employment experience, scholarships, awards, and conference presentations (max six (6) pages; can be in CV format):
3. Referees (Attach letters from your three referees; max two (2) pages each):
Name / Position/Department / Institution
4. Supplementary Materials
Supporting documents are to be attached to application — see “application instructions” for details
5. Other Current Funding Applications Pending:
SSHRC / NSERC / CIHR
Other (including international funding)—Please specify:
6. Where did you learn about the Killam Postdoctoral Fellowship programme?
Dalhousie University’s Faculty of Graduate Studies Website
Direct contact with Department/supervisors
Advertisement (indicate publication): / Nature / Chronicle of Higher Education / THES
CAUT Bulletin / University Affairs
Other (Please specify):
Name of Candidate / Signature of Candidate / Date
Forward completed application and supporting documents to:
Killam Postdoctoral Fellowship Committee
c/o Chair of the Department to which the candidate is applying
Dalhousie University
PO BOX 15000
Halifax, NS, Canada, B3H 4R2
Revised October 2014