2012 Application by vICa5Ok

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									      EIRR21st CIHR Strategic Training Program in Radiation
                            Medicine

                         CONTENTS OF COMPLETE APPLICATION


A. Application Form

   The original application form must be submitted online to the address below.


B. Enclosures

   Official transcripts of the applicant’s academic record (undergraduate and graduate degrees).

   Three reference letters submitted directly by the referees. Additional assessments will not be
   considered. These should include (if applicable) an assessment from your most recent research
   supervisor.


C. Submission

   Completed applications must be received by Friday, August 3, 2012 at 5 PM.

   Applications, official transcripts, and reference letters (submitted separately by the referees) must be
   submitted online at: http://www.eirr21.utoronto.ca/prospective/application-process



               LATE OR INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED
       EIRR21st CIHR Strategic Training Program in Radiation Medicine
                                        APPLICATION FORM

                COMPLETE AND FORWARD THIS SHEET WITH YOUR APPLICATION



This page is for EIRR use only, for the purposes of communication with the applicant. It will not be
included in the evaluation of the application.

Name & Title:

Mailing Address (for Correspondence):           Permanent Address (if different than mailing address):




Telephone Numbers                               Electronic Addresses

Office:                                         Email:

Laboratory:                                     Alternate Email:

Home:

Cellular:                                       Web homepage:

Fax:




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Name of Candidate

I Academic/Training Background
a) Academic Background:
Indicate all university degrees or diplomas obtained and those in progress starting with the most recent.

      Degree           Subject of Degree          Institution/Country        Start Date     Date Received
                                                                            (MM/YYYY)        or Expected
                                                                                             (MM/YYYY)




b) Training Experience:
Indicate all undergraduate, graduate, postdoctoral or fellowship research training experience, beginning
with the most recent training.


    Training type     Institution, Department         Supervisor(s)          Start Date       End Date or
                            and Country                                     (MM/YYYY)          Expected
                                                                                              (MM/YYYY)




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Name of Candidate

Interruption in training (optional)

If there has been any interruption(s) in pursuit of your training in academia, scientific research, etc., please
provide a brief explanation in the space below. List the period and reason for interruption (family or health
reasons, etc.)
Common examples of an interruption/delay leading to periods of low productivity might be a bereavement
period following the death of a loved one, maternity/parental leave or relocation of your research
environment.




II Work Experience

Start with the most recent, indicate your current position, where applicable, and other academic and non-
academic position(s) since the beginning of your university studies. For your current positions, leave the
end date blank.

     Position           Organization and              Faculty and               Start Date         End Date
                            Country                Department/School:          (MM/YYYY)         (MM/YYYY)




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Name of Candidate

III Credentials

List any qualifications, certificates and licenses completed, beginning with the most recent.

          Title                                Organization                         Start Date   End Date
                                                                                     (M/D/Y)      (M/D/Y)




IV Distinctions

Starting with the most recent, list post secondary honours, awards and scholarships, including name of
awarding organization and date awarded. For monetary awards, include the start and end dates, value of
the award and yearly stipend.

     Name of Award           Award Value           Awarding            Date         Start Date   Yearly
                                                  Organization        Awarded       End Date     Stipend
                                                                                   (MM/YYYY)




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Name of Candidate


Distinctions (Continued)

    Name of Award            Award Value          Awarding            Date        Start Date      Yearly
                                                 Organization        Awarded       End Date       Stipend
                                                                                  (MM/YYYY)




V Publications

List all publications over course of career on the following page. Additional pages may be added, if
required. If a paper has recently been accepted for publication or is in press, please attach acceptance
letter.

Examples of publications include:
Refereed Papers (original articles published in journals with editorial review)
Books and Monographs (as author or editor)
Book Chapters/Contributions to a collective work derived from conferences or symposiums
Abstracts/Notes (including name of journal and title or article and date submitted)
Invited Presentations (including conferences, presentations, demonstrations, workshops destined for a
non-academic audience)
Patents submitted or held
Publications




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Name of Candidate

Publications (Continued)




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Name of Candidate

VI Research Proposal

Title of proposed research project (12 words or less):

Provide up to 10 keywords to describe this research project:


Proposed EIRR21st supervisor name, department, and institution (with address) at which you wish to
carry out research training:


Proposed project duration (1 or 2 years):
For Re-submissions, applicants can provide an additional maximum 2-pages, single-spaced, font
12 Response to Previous Reviewers' Comments.
For Re-submissions, applicants can provide an additional maximum 2-pages, single-spaced, font
12 Response to Previous Reviewers' Comments.

Nature of the Proposed Research:

Describe the rationale, objective and experimental approach, as well as timeline of the proposed
research. Highlight its relevance to the field of radiation medicine and the transdisciplinary nature of
the project, clearly defining your role within the collaborative project.

Not to exceed the space provided. Applications should be single-spaced using a font no smaller than 12
point. Condensed types of spacing will not be acceptable.

Applicants are expected to discuss their application and proposed project with their supervisor or potential
supervisors.
Proposed Research Project:




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Name of Candidate

Proposed Research Project (Continued)




It is expected that this was written collaboratively by applicant and supervisor.




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Name of Candidate

VII Letter of Intent

In the space provided, state how the EIRR21st program, as you perceive it, will help you achieve your
long-term career goals as an independent researcher. Tell us why you want to do transdisciplinary
radiation medicine research, what you expect to get out of this program and how you plan to contribute to
the institution at which you wish to carry out your training.




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Name of Candidate

VIII Referees

Candidates must ask three individuals to provide assessments on their behalf. These should include (if
applicable) an assessment from your most recent research supervisor. Give the names of the individuals
whose assessments accompany this application.
         Name of Referee/               Current Position Held                    Institution
     Relationship to Candidate
1.


2.


3.




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