Undergraduate Researcher Stipend Application Form
Note: This is a template only. You may use this form to
work on your application offline and to save your work in
progress. You must copy your final responses into the
online form and submit your application online by the
deadline. Hard copy applications will not be accepted.
The Undergraduate Researcher Stipend enables undergraduate students to carry out mentored research
projects and creative works activities. This stipend allows undergraduate students to enrich their university
experience through hands-on discovery and skill development in a research-intensive university. Priority is
given to interdisciplinary work.
Instructions: Please complete the form and submit it online.
The application is due October 29, 2012 by 11:59 p.m. Incomplete applications will not be reviewed. You will
be notified of the funding decision within three weeks of the application deadline.
Please email email@example.com for more information or for assistance in completing this form.
Part 1. Personal Information
Current year of study:
Are you a student with Satisfactory Academic Standing?
You must hold a satisfactory academic standing prior to the start of the project (see Calendar Section 23.6,
Have you ever received the URI Undergraduate Researcher Stipend before?
Students are only eligible to hold one URI Undergraduate Researcher Stipend during their degree program.
International students only: Have you confirmed that you are eligible for this award?
International students: Please contact the University of Alberta International Centre
(http://www.uofaweb.ualberta.ca/uai/) to confirm you have the correct work permits prior to applying.
Part 2. Project Proposal
Name of supervisor:
Your supervisor is the person provides day-to-day mentorship and support for your project. If your supervisor is
not a faculty member at the University of Alberta, you will also need a faculty sponsor.
Name of U of A Faculty Sponsor (if applicable)
Project start date (mm/dd/yyyy):
Note: Projects must commence within 60 days of award notification.
Project end date (mm/dd/yyyy):
The stipend can be taken for 4 months of full-time research, or up to 12 months of part-time research.
Briefly describe the objectives of your project, your methods, and the expected outcomes of the research.
Abstracts may be used for publication purposes; please use non-technical terms and write for a general
audience. (max. 150 words)
Provide a detailed description of your proposed project, including project objectives or research questions,
background, methods, expected outcomes, and anticipated personal skill development. Your proposal will be
reviewed by a multidisciplinary committee; please define technical terms, avoid jargon, and write for a general
audience. A comprehensive reference list/bibliography is not required. (max. 1000 words)
Interdisciplinary aspects of the project:
Describe the interdisciplinary nature of the project. Interdisciplinary work involves integrating or synthesizing
methods, techniques, concepts, and/or approaches from different disciplines. Writing and illustrating a story or
essay, researching sustainable development in rural areas, and developing team approaches to providing
health care are a few examples of interdisciplinary research. (max 150 words)
I have read and understood the terms of the Undergraduate Researcher Stipend.
I understand that if my application is successful, I must submit a brief report within 10 days of the completion of
my project, and that I am strongly encouraged to present my work at an on-campus venue. If my project
involves research on humans or animals, I have made arrangements with my supervisor to obtain the required
ethics certification for my project. I also understand that I may not hold another award for the same project at
the same time.
Supervisor's statement (to be written by the supervisor):
Provide a brief statement regarding the student's initiative and potential to complete the proposed project,
interdisciplinarity of the project, benefit to the student, and how the student will be mentored in the project.
Indicate how you plan to monitor the student's progress and provide feedback (e.g. weekly contact hours,
communication, reporting expectations). (max. 500 words).
My application is complete and ready for adjudication.*
Protection of Privacy – The personal information requested on this form is collected under the authority of
Section 33 (c) of the Alberta Freedom of Information and Protection of Privacy Act and will be protected under
Part 2 of that Act. It will be used for the purpose of adjudication and administration of the URI Undergraduate
Researcher Stipend. Direct any questions about this collection to: FOIPP Liaison Officer, Office of the Provost
and Vice- President (Academic), 2-10 University Hall, Edmonton, AB T6G 2J9; tel (780) 492-3920; fax (780)