KCRNC-KCC-CUASF Kidney Cancer Research Grant | CUASF – Canadian Urological Association Scholarship Foundation

Name (in full) *

Mailing Address *

Email address *

Telephone # work *

Telephone # home *

Fax *

Post-graduate training (please list chronologically, Institution, dates and supervisors) *

Honours and Awards *

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

Title of Proposed Research *

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

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

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

Briefly describe the environment and the research facilities where the current research will be conducted *

Describe briefly your long-term career plans and research objectives and how this project will impact your research objectives *

Date *

Place *

Name of Applicant *

Research Proposal (include a clearly identified summary not exceeding 5 single-spaced, 12 font, typewritten pages)

2 Curriculum Vitae (Main Applicant & Supervisor)

Current Funding (Title of Award, Source, Period, Amount & Granted or Pending)

Letter of Support from your Department/Division Chair

Two (2) Letters of Recommendation