Studentship application
(Application deadline : January 15 of each year)

Fill and print this form (must be in 12 copies). To print the form, first click on the "View" button at the
bottom of this page. And then on next page, use the print button from your browser.

Outline of research program

1. Sex  M   F  
2. Name
3. First name
4. Date of birth (MM/DD/YY)  /  / 
5. Place of birth
6. Citizenship
7. Resident in Canada since
8. Adress, phone number and e-mail

9. Degree(s) obtained or expected

Degree Program University Date
* (Academic transcripts should be forwarded to Foundation at the latest January 15)

10. List the awards (undergraduate and graduate) you have received, indicating where and when held.

11. Studies for which studentship support is sought.

Degree Program University  
 

12. Date of beginning of studentship:   (MM/DD/YY)

13. List chronologically research or related experience; give present employment if not attending university.

14. List of your publications (including memory and / or thesis if necessary).


15. Other awards applied for (agency, program and dates of eventual tenure).

16. Location of proposed research.

Department Institution Supervisor

17. Give title of proposed research project.

18. Give the name of two individuals whom you have asked to forward letters of recommendation directly to the foundation.
* (You have to make sure that the letters will be received before January 15)

Signatures


Applicant
Proposed Supervisor
Date


Head of the Department
(of proposed graduate training)
Name





Research program (in 400 words or less)
Outline the research program upon which you propose to work.


 

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230 rue Foch, Saint-Jean-sur-Richelieu (Québec) Canada J3B 2B2
Tel. (450) 358-9779 Fax (450) 346-1045