Application Form Graduate Student Research Awards€¦ · Supervisor Information Name Email...

2017 Asthma Canada / AllerGen Graduate Research Awards 1

Deadline for Submission: September 30, 2017 (11:59 pm)

Applicant Information

Name Institution

Project Title

Address

City Province Postal Code Email

Degree Program/Discipline Start Date dd/mm/year

End Date dd/mm/year

Phone (Cell) GPA

Supervisor Information

Name Email Telephone

Institution Program (Faculty/Department)

Address City Province Postal Code

Who wrote the project description included in this application? Please indicate which best applies:

Student Supervisor Combination Other (please specify)

Research Award funding in-hand or pending

Name of Organization Award Value Date (mm/year)

Application Form – Graduate Student Research Awards

2017 Asthma Canada / AllerGen Graduate Research Awards 2

Describe your role in the research project. (Maximum 200 words)

Describe how this project complements your long-term career goals. (Maximum 200 words)

2017 Asthma Canada / AllerGen Graduate Research Awards 3

Describe the training environment to be provided by the supervisor and host institution. (Maximum 200 words)

Application Submission

Completed applications must be sent electronically in a single PDF to Jenna Reynolds at

jenna.reynolds@asthma.ca no later than September 30, 2017 (11:59 pm). Late applications will not be

accepted.

Successful applicants will be notified no later than November 30, 2017.

For more information contact:

Jenna Reynolds

Director, Programs and Services, Asthma Canada

jenna.reynolds@asthma.ca

416-787-4050 x101

Signatures: I hereby understand and agree that any award made as a result of this application will be

subject to the Asthma Canada / AllerGen NCE Inc. terms and conditions governing these awards.

Applicant Name Signature Date

Supervisor Name Signature Date