CUASF – Canadian Urological Association Scholarship Foundation
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CUASF Early Investigator Research Scholarship
Terms of Reference
Application Form
CUASF – Bladder Cancer Canada Research Grant
Terms of Reference
Application Form
CUASF-SIU International Scholarship Program
Terms of Reference
Application Form
CUASF-KCRNC-KCC Research Grant Program
Terms of Reference
Application Form
CUASF - CMSHC (Canadian Men's Sexual Health Council) Grant
Terms of Reference
Application Form
CUA Community Urologist CPD and CUC-CUA Mentorship Grant Programs
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CUA-Pfizer Incontinence Fellowship Grant
Form type
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Name (in full)
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Date of birth
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CUA Membership Number
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Citizenship
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Mailing Address
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Email address
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Telephone # work
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Telephone # home
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Fax
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Location of Residency Training
Year of Residency
Name of Institution and Department where applicant will conduct his/her academic/research activities
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Academic Rank to be held by the applicant during tenure of the research
Name, address and telephone number of the Department/Division Chair person
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Name of Supervisor of Research Project
Type of Research (eg. Clinical, translational, interventional, basic research, genetic studies, epidemiology, health outcomes, and quality of life studies)
Research Experience (a brief description of work in which the applicant has participated)
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Briefly describe the environment and the research facilities
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Briefly describe your long term career plans and research objectives and how this fellowship will impact these objectives
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Date
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Place
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Name of Applicant
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Checklist
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Curriculum Vitae of Fellow (Please submit a pdf version of your Common (CIHR) CV)
Research proposal outlining the clinical and/or research project for the fellowship not exceeding (5) single spaced pages including budget and references all in standard 12 font (please see suggested headings outlined below). Note: The CUA-Pfizer Incontinence Fellowship Award is not intended to fund the research project. The institution at which the fellowship takes place will need to provide funding for the research project.
A maximum of three (3) published reprints or pre-prints (if applicable)
Project budget
A detailed plan to apply for appropriate Ethics Committee approval and Regulatory approval (Clinical Trial Application in cases of non-marketed drugs or marketed drugs where the proposed use is outside the parameters of the Notice of Compliance) must be included along with the consent forms where human subjects are involved in the research project considered.
Letter of support from the academic institution fellowship program director or alternate agreeing to conform to the Terms of Reference. The letter should indicate the level of non-monetary support, infrastructure and commitment by the university/institution for the candidate.
Letter(s) of support from proposed mentors describing how they will execute their mentorship to facilitate successful completion of the proposed research
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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.
A brief lay Summary (maximum of 250 words).
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).
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