CUA Scholarship Fund – Bladder Cancer Canada | CUASF – Canadian Urological Association Scholarship Foundation

Name (in full) *

Date of birth *

CUA Membership Number *

Citizenship *

Mailing Address *

Email address *

Telephone # work *

Telephone # home *

Fax *

Name of Institution and Department where applicant will conduct his/her academic/research activities *

Academic Rank to be held by the applicant during tenure of the research *

Name, address and telephone number of the Department/Division Chair person *

Research Experience (a brief description of work in which the applicant has participated) *

Briefly describe the environment and the research facilities *

Briefly describe your long term career plans and research objectives and how this project will impact these objectives *

Date *

Place *

Name of Applicant *

Checklist

Research Proposal not exceeding five (5) single spaced, typewritten pages (Please refer to “Guidelines for Application Submission” for suggested headings)

Summary of the research proposal not exceeding one (1) single spaced, typewritten page

Curriculum Vitae (Please submit a pdf version of your Common (CIHR) CV)

Letter of support from the Department/Division Chair supporting this application and agreeing to conform to the Terms of Reference. The letter should indicate the level of support and commitment by the university/institution for the candidate.

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.

Renewal Applications

In addition to the items listed above, renewal applications must include a progress report.