Graduate_Student_Award_Application_Form1257 by keralaguest

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									                                    APPLICATION FORM
                              2011/2012 FACULTY OF MEDICINE
                               GRADUATE STUDENT AWARDS
    The Graduate Student Awards are available to graduate students registered in the UBC Faculty of
  Medicine or supervised by a faculty member with a primary appointment in the Faculty of Medicine.
    Please note: For the Javier O. Aragon Graduate Scholarship in Cancer Research, student must be
 registered in the Faculty of Medicine. Students must be registered before the awards are adjudicated.
  Students graduating in December 2011 are eligible for consideration; however, students who register
       in January 2012 will not be eligible as adjudication will occur prior to their registration. This
        competition is open to students irrespective of citizenship. Please see last page for Award
                                                Descriptions.

                               A complete application includes:
1. Completed Application Form

2. Post-Secondary Transcripts.
   Copies of transcripts are accepted but must be initialed by the graduate secretary or advisor of the
   student’s program (if submitting official transcripts initialing is not required).

3. Two Sponsor’s Letters.
   Each sponsor should be asked to comment on the student’s research achievements, research
   potential, interpersonal skills, and greatest strengths and weaknesses. Sponsors should be made
   aware of the conditions of the award(s) for which the student is applying and should be asked to
   comment on the applicability of the intended research program for the award(s). The letters should
   be addressed to the Associate Dean, Graduate & Postdoctoral Education, and must be submitted in
   envelopes sealed and endorsed by the sponsor (the original sealed and endorsed from each sponsor).
   These may be sent separately but must be received by the application deadline.

                       PLEASE DO NOT USE STAPLES OR DOUBLE SIDED PRINTING.


                                        Send complete application
                              (including transcripts and sponsor’s letters) to:

                                            Dr. Peter Leung
                           Associate Dean, Graduate & Postdoctoral Education
                                          Faculty of Medicine
                                     #317-2194 Health Sciences Mall
                                         Vancouver, BC V6T 1Z3


                                           DEADLINE:
                                    June 24th, 2011
                           If you have any questions regarding this process,
                  please contact 604-822-8633 or e-mail adrienne.hammond@ubc.ca
                   UNIVERSITY OF BRITISH COLUMBIA
                                            FACULTY OF MEDICINE
                                      Graduate Student Awards
                                          A p p l i c a t i o n Form
Deadline: June 24th, 2011

Please indicate [] award(s) applied for:
#00139                Edward Squires Memorial Scholarship
#00140                Roman M. Babicki Fellowship in Medical Research: Cancer Research
#00388                BC Foundation for Non-Animal Research – Evelyn Martin Award
#06330                Millie and Ralph Drabinsky Graduate Scholarship in Medicine
#06373                Dorothy May Ladner Memorial Fellowship
                      Mary Adele Norman Graduate Award in Medical Research
#6422                 Javier O. Aragon Graduate Scholarship in Cancer Research


Family Name:                                                Given Name:



Student Number:



Current Mailing Address:                                    Permanent Mailing Address:




Tel (work/cell):                                            Tel (home):



Fax:                                                        E-mail:



Location of Proposed Training:                              Mailing Address of Training Location:




Department/Program Name:



Supervisor:                                                 Supervisor’s Tel:



Supervisor’s Department:                                    Supervisor’s E-mail:




                                                                                                    Page 2 of 5
                   UNIVERSITY OF BRITISH COLUMBIA
                                             FACULTY OF MEDICINE

                                       Graduate Student Awards
                                           Application Form

Please indicate your degree program and the starting date (if you have transferred from the Masters to the PhD
program without receiving a Masters, please indicate the start date of your graduate program).
        Masters         Start Date (Month/Year):


        Doctoral        Start Date (Month/Year):




List research or related experience chronologically.


Research/Experience                                                                          Date




List undergraduate and graduate awards received, stating where and when held:
Award                        Amount                Held Where                       Dates Held (Start/End)




List publications, including title, journal, & authors.




                                                                                                             Page 2 of 5
                   UNIVERSITY OF BRITISH COLUMBIA
                                               FACULTY OF MEDICINE
                                          Graduate Student Awards
                                              Application Form


Research Project. Describe your project in your own words. No more than one additional page may be appended (use a 12-pt font)




Please indicate the names of the two sponsors providing letters:
Sponsor 1:                                                           Sponsor 2:




The undersigned agree that the general conditions governing all funding of the Edward Squires, Roman M. Babicki,
Evelyn Martin, Millie and Ralph Drabinsky, Dorothy May Ladner, Mary Adele Norman, and the Javier O. Aragon
Awards as set out in the attached guidelines, apply to any award made pursuant to this application and are hereby
accepted by the applicant and the department in which the student is receiving the training.




                        Applicant Signature                                                 Supervisor Signature




                         Applicant Name                                                       Supervisor Name




                               Date                                                                 Date




                                                                                                                           Page 2 of 5
                UNIVERSITY OF BRITISH COLUMBIA
                                         FACULTY OF MEDICINE

                          Graduate Student Award Descriptions

Note: As these amounts have not yet been finalized, these values may be subject to change.

1.   Award #00139 – Edward Squires Memorial Scholarship
     A $2,400 scholarship has been endowed by Mrs. Katherine Borden, in memory of her son. The award is made
     on the recommendation of the Faculty of Medicine in consultation with the Faculty of Graduate Studies to a
     student undertaking research into spinal meningitis or related diseases of the nervous system.

2.   Award #00140 – Roman M. Babicki Fellowship in Medical Research
     Two $20,000 fellowships have been endowed by Roman M. Babicki. The awards are to support doctoral
     candidates in any academic department, provided that their supervisor has a primary appointment in the
     Faculty of Medicine. Candidates must be undertaking cancer research (two awards). No individual or project
     will receive support from this fund for more than two consecutive years. The awards are made on the
     recommendation of the Faculty of Medicine in consultation with the Faculty of Graduate Studies.

3.   Award #00388 – BC Foundation for Non-Animal Research – Evelyn Martin
     A fellowship of $10,000 has been made available by the BC Foundation for Non-Animal Research to support a
     student majoring in human tissue and cell culture techniques in cancer research with particular emphasis on
     chemical carcinogenesis and chemo prevention. The award is made on the recommendation of the Faculty of
     Medicine.

4.   Award #06330 – Millie and Ralph Drabinsky Graduate Scholarship in Medicine
                                                                                                           th
     A $240 scholarship has been endowed by family and friends in honor of Ralph and Millie Drabinsky’s 50
     wedding anniversary. The award is offered to a masters or doctoral student undertaking research into the
     etiology or treatment of Alzheimer’s or related neurodegenerative diseases of the central nervous system.
     No individual will receive support from this fund for more than two consecutive years. The award is made on
     the recommendation of the Faculty of Medicine in consultation with the Faculty of Graduate Studies.

5.   Award # 06373 – Dorothy May Ladner Memorial Fellowship
     A $5,250 fellowship has been endowed in memory of Dorothy May Ladner through a bequest by her sister,
     Edna G. Ladner, for a graduate student doing research which could lead to the effective treatment of
     traumatic brain injury. One of the first women from British Columbia to receive a master’s degree in public
     health nursing, Dorothy Ladner was known throughout the province for her administrative skills in public
     health. She assisted with the development of the Variety Club's Children's Treatment Centre in Surrey of which
     she later became Director. The awards are made on the recommendation of the Faculty of Medicine.

6.   Mary Adele Norman Graduate Award in Medical Research
     A $3,500 scholarship has been endowed by Mary Adele Norman for graduate students doing medical research.
     This award is administered by the Faculty of Medicine.

7.   Award # 6422 - Javier O. Aragon Graduate Scholarship in Cancer Research
     A $2000 scholarship is available to graduate students currently registered in the UBC Faculty of Medicine. The
     competition is open to students irrespective of citizenship. Preference will be given to a doctoral student
     researching cancers of the lung, liver, colon or brain. This scholarship is offered by Husayn and Britta Moody,
     in memory of his father-in-law and her father, Javier O. Aragon, to a graduate student in the Faculty of
     Medicine who is engaged in cancer research. The award is made on the recommendation of the Faculty of
     Medicine in consultation with the Faculty of Graduate Studies.




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