TRAINING AWARD FOR DOCTORAL STUDENTS IN GERIATRIC NURSING
2008 Financial Support Application Form
Deadline: February 15,2008
Program Director: Philippe Voyer, R.N., Ph.D., Associate Professor, Faculty of Nursing, Université Laval
Assistant Program Director: Francine Ducharme, R.N., Ph.D., Full Professor, Faculty of Nursing, Université de Montréal
Documents submitted
(a)Completed application form
(b)Curriculum vitae (see below)
(c)Official academic transcripts for all courses taken (certificate, bachelor’s degree, master’s degree, doctoral degree, etc.), whether completed or not
(d)Evaluation letters from two professors or researchers who have participated in the applicant’s training
(e)Applicant’s letter applying for student membership in the Quebec Network for Research on Aging
(f)Letter explaining how this doctoral research project will contribute to the development of the applicant’s career as a clinician investigator in the field of geriatric nursing
(g)Thesis supervisor’s Common CV
(h)Letters from the Faculty of Nursing and the clinical setting in Quebec

Submit 4 copiesof all of the above documents to:

Nathalie Walter, Ph.D.

FORMSAV

Centre de recherche - Institut universitaire de gériatrie de Montréal

4565 Queen Mary Road

Montreal,Quebec

H3W 1W5

Member of Quebec Network for Research on Aging (mandatory): YesNo

1. Contact information

Last name: / First name:
E-mail:

2. Training program

Title:
Department or School:
University:
Date enrolled in program(mm/yyyy)
Date degree expected to be received(mm/yyyy)

3. Title of research project (maximum 3 lines; do not use all capital letters)

4. Description of research project (maximum 2 pages)

Background on the research problem, hypotheses and objectives, methods and analyses, originality of project and contribution to the advancement of knowledge, 5 key references

4. Description of research project (continued)

5. Applicant’s motivation

Relationships between the project, the objectives of the Quebec Network for Research on Aging, and the applicant’s experiences with regard to aging (maximum 1000 characters, including spaces)

6. Commitments

Thesis supervisor
  • Supervisor (last name, first name)

By signing this form, the thesis supervisor confirms that he or she is a member of the Quebec Network for Research on Aging and agrees to supervise the applicant’s clinical research project on geriatric nursing.
Supervisor’s signature / Date
Clinical setting
  • Representative of management of the clinical setting (last name, first name)

agrees to provide the student who receives this award with support for a clinical research project on geriatric nursing.
Applicant
  • The applicant, (last name, first name),

hereby agrees to conduct a clinical research project on geriatric nursing.
Applicant’s signature / Date

Form, Page 1

CV Module
Last name / First name(s) / Initial(s)
Contact information
Home address / Temporary address / Address of host institution
From (date):
To (date):
Telephone / Fax / E-mail and Web addresses
Home / Home / E-mail
Work / Work
Cell / Web
Citizenship / Permanent resident status in Canada
Canadian / Other / Permanent resident / Effective date / (DD/MM/YYYY)
Country
Language of correspondence / Language skills
English French / ReadWriteSpeakUnderstand
English (Yes/No)
Gender / Date of birth / French (Yes/No)
Male Female / (DD/MM/YYYY) / Other languages (specify)
Signature / Date

Module CV, Page 1

Last name, First name:

UNIVERSITY EDUCATION/RESEARCH TRAINING

Enter all of the university degrees that you have completed and any that you are in the process of completing, starting with the most recent. If you hold any degrees issued by more than one institution (for example, a doctorate completed under the Quebec/France agreement "Soutien aux cotutelles de thèse de doctorat"), enter the name of each institution separately.

Also enter any research training experiences that you have had.

If there is any field below in which you have no information to enter (for example, in the “Research supervisor” column for your bachelor’s degree), enter n/a instead.

Degree[1]/ Type of training / Name of degree and field of specialization / Institution and country / Research supervisor / Date studies began
(MM/YYYY) / Date degree received
(MM/YYYY)

Module CV, Page 1

Last name, First name:

PROFESSIONAL EXPERIENCE

Start with your most recent professional experience, indicating your current position, if any, and then list all of your other professional experiences since you began your university studies. For your current position, leave the end date blank.

If you have any experience in supervising students, either alone or in collaboration with other academics, enter it in this table and specify the level of the student(s) whom you supervised.

Position / Institution and country / Faculty and Department/ School / Start
(MM/YYYY) / End
(MM/YYYY)

CV Module, Page 1

Last name, First name:

OTHER ACTIVITIES

Start with the activities in which you are currently involved in your academic setting,[2]and then list all the others. For your current activities, leave the end date blank.

Activity / Institution / Start date
(MM/YYYY) / End date
(MM/YYYY)

Last name, First name:

SCHOLARSHIPS, FELLOWSHIPS, AND OTHER AWARDS AND HONOURS

Enter all scholarships, fellowships, and other awards and honours that you have received, starting with the most recent.

Name and type / Institution and country / Start date
(MM/YYYY) / End date
(MM/YYYY) / Field of specialization / Total amount

CV Module, Page 1

Last name, First name:

PUBLICATIONS

You must provide two sets of information on your publications: enter the total number of each type of publication in the following table, and attach a detailed list of your publications in the format specified below.

Publications / Peer-reviewed articles / Books and monographs / Contributions to collective works/
Book chapters / Abstracts/ Summaries / Invitations to present at conferences / TOTAL
Published
Accepted or in press

List of publications

List book chapters, journal articles, summaries of communications, and scientific communications separately, in the following formats:

Hamel, G., and Tremblay, C. (2004). “Chapter title” in G. Hamel and T. Dupuis (Eds.). Book Title.City: Publisher.

Tremblay, C., Dupuis, T., and Hamel, G. (2005). “Title of article”. Name of Journal, 6, 23-25.

Tremblay, C., and Hamel, G. (2005). “Title of presentation”. Xth Conference of Y Discipline. Montreal (Canada), June 5-7, 2005.

CV Module, Page 61

[1]Doctor of Medicine (M.D.), Doctor of Philosophy (Ph.D.), Master’s, Bachelor’s, Licence, DEA, other.

[2]Examples: student association, research ethics committee, student representative, etc.