Waterloo Institute for Nanotechnology

Nanofellowship Application Form

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A1. PERSONAL INFORMATION Family Name

Given Name(s)

Telephone Number

Email

UW Student ID (8 Numbers)

Address #1

Address #2

City

Province/State

Country

Postal Code

A2. CITIZENSHIP (Please indicate your country of citizenship and status, ie: Permanent Resident):

B1. CURRENT PROGRAM Are you currently enrolled as a Graduate Student at the University of Waterloo? (If ‘No’ proceed to Section B2. Proposed Program) Yes No

If Yes, enter your program information below: Degree Program

Department

Supervisor (If Applicable)

Supervisor’s Email

Start Date (mm/yy)

Anticipated Completion Date

B2. PROPOSED PROGRAM If you are not currently registered as a Graduate Student at UW, please provide information about your Proposed Program when you enroll in a UW Graduate Program, or if you are completing one degree and continuing Graduate Studies at UW.

Proposed Degree Program

Proposed Department

Proposed Supervisor

Proposed Supervisor’s Email

Proposed Starting Date

C1. ACADEMIC BACKGROUND Provide degree(s) completed or in progress in chronological order. Indicate anticipated completion date for degrees in progress.

Degree Department Institution Country Academic Average

Start and Completion Dates (mm/yy-mm/yy)

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Nanofellowship Application Form

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C1. ACADEMIC BACKGROUND (continued)

Degree Department Institution Country Academic Average

Start and Completion Dates (mm/yy-mm/yy)

C2. AWARDS AND SCHOLARSHIPS List awards and scholarships (and other honours) in reverse chronological order (most recent first.) Please indicate if the award is declined in brackets under the name of the award.

Date (mm/yy-mm/yy)

Name of Award or Scholarship Country (if not Canada) Value

Level (eg: University, Regional,

National)

If more room is required, ATTACH ADDITIONAL AWARDS AND SCHOLARSHIPS and/or DEGREES COMPLETED HERE (PDF) (instructions on pg. 9)

Waterloo Institute for Nanotechnology

Nanofellowship Application Form

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C3. ACADEMIC RESEARCH AND RELEVANT WORK EXPERIENCE List job positions in reverse chronological order (most recent first). Indicate if the experience gained was part of a program of study. Please include Job Title, Organization and Department and Period of time worked (in the format mm/yy-mm/yy) for all positions. For research positions, additionally include Supervisor and Project Title.

If more room is required, ATTACH ADDITIONAL WORK EXPERIENCE HERE (PDF) (instructions on pg. 9)

Waterloo Institute for Nanotechnology

Nanofellowship Application Form

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Please use the following format for publications: Please include the full authorship as it appears/will appear in the original publication, with the applicant’s name in bold. Make sure that full authorship, year, title, publication name and volume, and page numbers are included in your citations. C4. PUBLICATIONS AND PRESENTATIONS List publications and presentations in reverse chronological order (most recent first) according to the categories given.

a. Articles published, in press, and/or accepted in refereed journals, and articles submitted to refereed journals with submission number

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Nanofellowship Application Form

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C4. PUBLICATIONS AND PRESENTATIONS (CONTINUED) List publications and presentations in reverse chronological order (most recent first) according to the categories given.

b. Refereed conference proceedings and abstracts, and invited communications, reports, and book chapters

c. Non-refereed contributions such as technical reports, conference presentations, posters, and patents

If more room is required, ATTACH ADDITIONAL PUBLICATIONS AND PRESENTATIONS HERE (PDF) (instructions on pg. 9)

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C5. ADDITIONAL ACHIEVEMENTS AND/OR SPECIAL CIRCUMSTANCES (OPTIONAL) If you would like to report any additional achievements which do not fit into categories 1-4, you may do so here. Examples: Leadership, volunteer experience, management etc. You may also note any special circumstances.

D. TRANSCRIPTS Please provide your transcripts for all degree programs you have obtained (Bsc, MSc, PhD). If you have already started your proposed program of study at the time of application, you must also submit a transcript for this program of study along with your application, regardless of the number of months completed in the program.

ATTACH YOUR TRANSCRIPTS HERE (PDF) (instructions on pg. 9)

For non-UW transcripts, please include one copy of the legend on the back of your transcript, to help the reviewers understand the grading system at your university. All of your transcripts must be provided in a single PDF file. Black and white scans will be accepted. An official copy of the transcripts may be requested for verification in the review process.

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Nanofellowship Application Form

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E. DESCRIPTION of PROPOSED RESEARCH (500 words maximum) Clearly describe the proposed research project that interests you and its relevance to nanotechnology in the field provided below. Entries greater than 500 words will not be considered. The originality and relevance of the proposed research will be an important element in the evaluation. Special consideration will be given to students intending to pursue projects involving cross-disciplinary collaboration in nanotechnology.

PROJECT TITLE:

PROPOSAL:

Waterloo Institute for Nanotechnology

Nanofellowship Application Form

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Letters of Reference:

Applicants are encouraged to consider the full range of potential referees who could provide relevant evidence, perspectives, and insight to support the review of your application. It is the applicant's sole responsibility to follow up with referees to ensure the two Letters of Reference are submitted prior to the deadline indicated. You will receive a confirmation email stating the completeness of your application within three working days of receipt of the required documents by the WIN offices.

F. REFERENCE CONTACT INFORMATION

First Reference Name

Title

Telephone Number

Email

Institution

Department

Address #1

Address #2

City

Province/State

Country

Postal Code

Second Reference Name

Title

Telephone Number

Email

Institution

Department

Address #1

Address #2

City

Province/State

Country

Postal Code

If a referee informs you that the reference letter cannot be submitted within the set deadlines, please contact the WIN office at win@uwaterloo.ca to arrange an approved late submission date or replace an alternate referee as soon as possible. END OF APPLICATION

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Nanofellowship Application Form

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Instructions for Attaching Files to the Application:

Attachments must be in PDF form.

Acrobat, or Adobe Reader version 10 or higher are required to attach documents. The latest version of Adobe Reader can be downloaded at http://get.adobe.com/reader/

If you’re using Adobe Reader X (recommended) follow these instructions:

1. Click on “Comment” at the top right hand corner of the page 2. Under “Annotations” select the “Attach File” paperclip icon 3. Click in the appropriate space provided and select the file you would like to attach

If you’re using Adobe Acrobat or an older version of Adobe Reader, the same option can be found by selecting

Tools > Comment & Markup > Attach a File as a Comment (paperclip icon) from the top menu bar.

Your file should show up as a small paperclip icon in the box provided when it has been properly attached.

Application Check-list:

Application Form: I have completed all relevant fillable fields of this Nanofellowships Application Form (Sections A-C) I have combined all my transcripts into a single file (PDF) and attached them (Section D) I have provided the contact information for my references (Section F)

References: I am aware that it is my responsibility to ensure that my referees submit their reference letters prior to the

indicated deadline