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Trainee application
Personal information
First name
*
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*
Email
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Phone (Private)
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Phone (Work)
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Address
Country
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Afghanistan
Aland Islands
Albania
Algeria
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Paraguay
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Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
U.S. Virgin Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican
Venezuela
Vietnam
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Address 1
*
Address 2
City
*
Province
*
- Select -
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon Territory
Postal code
*
Mentor & Training information
Stipend Type Requested
*
Proposed CanHepC Mentor and Training
*
Biomedical Research
Clinical Research
Health System Services
Population Health Research
Training Institution
*
Mentor name
*
Address Institution
Country
*
Afghanistan
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
British Virgin Islands
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Caribbean Netherlands
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo (Brazzaville)
Congo (Kinshasa)
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong S.A.R., China
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Ivory Coast
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao S.A.R., China
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
North Korea
Norway
Oman
Pakistan
Palau
Palestinian Territory
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
U.S. Virgin Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican
Venezuela
Vietnam
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Address 1
*
Address 2
City
*
Province
*
- Select -
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon Territory
Postal code
*
Degree Expected / Fellowship
*
Masters
MD
Phd
Postdoctoral
Anticipated Graduation Date
*
Applicant Objectives and expectations
*
In the space provided below, please indicate your short-term objectives (1 to 2 years), long-term objectives (5 to 10 years), and how you think the CanHepC training program will help you achieve them. Max 500 words
How does your research align with the goals of CanHepC?
*
In the space below, please explain how your proposed research objectives are aligned with the goals of CanHepC (http://canhepc.ca/). Max 200 words
Applicant’s motive(s) for continuing a PhD or Postdoctoral research in the same group where they obtained their latest degree.
*
Max 200 words
Research Keywords
(list a maximum of 5 research keywords)
1
*
2
3
4
5
Research Project Summary
Title of research project
*
Where will the research for this project be done?
*
Who is or will be the supervisor?
*
In the space provided below, please describe your research project and how it relates to the objective of CanHepC.
*
Include the following sections: Background, Hypothesis, Experimental design, Expected Results, Significance & References. Max 500 words
Transdisciplinary Training
*
In the space provided below, please describe any previous transdisciplinary training or interdisciplinary research. Max 250 words
Additional Information
In the space provided below, please include any additional information you would like considered for your application. Max 250 words
Research Training Environment
*
In the space provided below, please describe the infrastructure, research and peer environment that will be available to the trainee. Max 250 words
How will sex and gender be considered in this project?
How will the principals of Equity, Diversity and Inclusion be considered in this project?
Documents to upload
Support letter from the mentor
*
Files must be less than
5 MB
.
Allowed file types:
pdf
.
Reference forms and letters (1)
Files must be less than
5 MB
.
Allowed file types:
pdf
.
Reference forms and letters (2)
Files must be less than
5 MB
.
Allowed file types:
pdf
.
Canadian Common CV
*
Files must be less than
5 MB
.
Allowed file types:
pdf
.
University Transcripts (1)
(not required for Postdocs)
Files must be less than
5 MB
.
Allowed file types:
pdf
.
University Transcripts (2)
(not required for Postdocs)
Files must be less than
5 MB
.
Allowed file types:
pdf
.
Proof of enrolment at University
Files must be less than
5 MB
.
Allowed file types:
pdf
.
Supervisor Canadian Common CV
*
Files must be less than
5 MB
.
Allowed file types:
pdf
.
Other document
Files must be less than
5 MB
.
Allowed file types:
pdf
.
Confirmations
Please confirm that each item is completed before submitting your application to the CanHepC
*
The applicant has confirmed and verified the contents of his/her application. If any of the information is found to be false, the application will be immediately rejected.
The applicant's application has been endorsed by an CanHepC co-applicant. Should it be otherwise, the applicant will be immediately rejected for membership into the CanHepC.
The applicant recognizes that if the CanHepC does not receive the supplemental documents by the application deadline, the application will neither be reviewed nor considered for acceptance into the CanHepC.