Subventions de recherche RRCRC-CRC-FBAUC sur le cancer du rein | FBAUC - Fondation des Bourses de l’Association des Urologues du Canada

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 *

Checklist

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 and commitment from the chair of the Department/Division indicating the level of institutional and university support.

Two Letters of Recommendation, at least one from an external source.

Current curriculum vitae of the applicant and the supervisor.

A brief lay Summary (maximum of 250 words).