CUASF Early Investigator Research Scholarship | CUASF – Canadian Urological Association Scholarship Foundation

Name (in full) *

Date of birth *

CUA Membership Number *

Citizenship *

Mailing Address *

Email address *

Telephone # work *

Telephone # home *

Fax *

Name of Institution and Department where applicant will conduct his/her academic/research activities *

Academic Rank to be held by the applicant during tenure of the research *

Name, address and telephone number of the Department/Division Chair person *

Research Experience (a brief description of work in which the applicant has participated) *

Briefly describe the environment and the research facilities *

Briefly describe your long term career plans and research objectives and how this project will impact these objectives *

Date *

Place *

Name of Applicant *

Checklist

Research Proposal not exceeding five (5) single spaced, typewritten pages in standard 12 font including budget and references (Please refer to “Guidelines for Application Submission” above for suggested headings.)

Curriculum Vitae (Please submit a pdf version of your Common (CIHR) CV)

Evidence of appropriate Ethics Committee approval or application for approval must be included along with the consent forms where human subjects are involved in the study

Letter of support from the Department/Division Chair supporting this application and agreeing to conform to the Terms of Reference. The letter should indicate the level of support and commitment by the University and the institution for the candidate

Two (2) additional letters of recommendation, one (1) of which should come from an individual not associated with the Institution where the proposed research will take place.

A list of all current grants and submitted grant applications in the past 3 years (maximum of 1-2 pages) with the title of the grant, granting agency and amount of the grant. Incomplete applications will be disqualified.

Renewal Applications

Renewal applications should include all of the above documentation. No Progress Report is required for a renewal application. Progress Reports are to be submitted at the mid-point of the original award (see above).