NSERC AMETHYST Application Form

Personal Information

Family Name

Given Name

Initial(s)

UofL ID

Addresses

Current Address

Permanent Mailing Address (If different from current address)

If current address is temporary, indicate leaving date

Month

Day

Year

Telephone number

Telephone number at permanent mailing address

Fax Number

Primary e-mail address

Citizenship

Please select one of the following three options that applies to you

Canadian Citizen

Permanent Resident of Canada

Other

Indicate date of landing as stated on official immigration document

Indicate country of citizenship

Acceptance

I hereby agree that any award made to me as a result of this application will be subject to the general conditions governing NSERC scholarships. *

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Academic Background

First Degree

Degree (most recently completed or currently in progress)

Discipline (major)

Department, Institution and Country

Month and Year started

Month

Day

Year

Month and Year awarded/expected

Month

Day

Year

Second Degree

Degree

Discipline (major)

Department, Institution and Country

Month and Year started

Month

Day

Year

Month and Year awarded/expected

Month

Day

Year

Third Degree

Degree

Discipline (major)

Department, Institution and Country

Month and Year started

Month

Day

Year

Month and Year awarded/expected

Month

Day

Year

Academic, Research and Other Relevant Work Experience

Position (please begin with most current)

First Position

Position title and Job description (also indicate full-time or part-time)

Organization and department

Supervisor and phone number

Start Period (YYYY/mm/dd)

Month

Day

Year

End Period (YYYY/mm/dd)

Month

Day

Year

Second Position

Position title and Job description (also indicate full-time or part-time)

Organization and department

Supervisor and phone number

Start Period (YYYY/mm/dd)

Month

Day

Year

End Period (YYYY/mm/dd)

Month

Day

Year

Third Position

Position title and Job description (also indicate full-time or part-time)

Organization and department

Supervisor and phone number

Start Period (YYYY/mm/dd)

Month

Day

Year

End Period (YYYY/mm/dd)

Month

Day

Year

AMETHYST Award Application

AMETHYST award you would like to apply for

Undergraduate (B.Sc.)

Graduate (M.Sc.)

Doctor of Philosophy (Ph.D.)

Post Doctoral Fellow (P.D.F.)

Proposed field of study / research

Proposed starting date of award (mm/yyyy)

Month

Day

Year

Title of proposed research (not applicable for B.Sc.)

List ten (10) key words that describe your proposed research, separated by commas (B.Sc. students should list a few imaging science topics they find interesting)

Briefly describe your proposed research in one paragraph (not applicable for B.Sc.).

Are you an SGS (School of Graduate Studies) Applicant? *

Yes

SGS Application

Indicate the total number of months of graduate studies (master’s or doctoral) you have or will have completed as of December 31st of the year of application in the natural sciences or engineering:

Months of full-time studies

Months of part-time studies

Indicate the number of months of studies you have or will have completed, as of December 31st of the year of application, in the program for which you are requesting funding:

Months of full-time studies

Months of part-time studies

Indicate if you are attending university at the time of application

Attending full time

Attending part-time

Not attending

Scholarships and Other Awards
Please list any scholarships or other awards you’ve received in the past (start with most recent)

Scholarship/Award 1

Name of award

Value (per annum) (CND$)

Level: Institutional, Provincial, National, International

Type: Academic, Research, Leadership, Communication

Location of tenure

Start Period (YYYY/mm/dd)

Month

Day

Year

End Period (YYYY/mm/dd)

Month

Day

Year

Scholarship/Award 2

Name of award

Value (per annum) (CND$)

Level: Institutional, Provincial, National, International

Type: Academic, Research, Leadership, Communication

Location of tenure

Start Period (YYYY/mm/dd)

Month

Day

Year

End Period (YYYY/mm/dd)

Month

Day

Year

Scholarship/Award 3

Name of award

Value (per annum) (CND$)

Level: Institutional, Provincial, National, International

Type: Academic, Research, Leadership, Communication

Location of tenure

Start Period (YYYY/mm/dd)

Month

Day

Year

End Period (YYYY/mm/dd)

Month

Day

Year

Thesis completed or in progress

First Degree

1. Degree

Supervisor and institution

Date completed or expected (mm/yyyy)

Month

Day

Year

Title of thesis

Second Degree

2. Degree

Supervisor and institution

Date completed or expected (mm/yyyy)

Month

Day

Year

Title of thesis

Summary of thesis most recently completed or in progress

Use plain English. Do not reproduce abstract of thesis.

Justification For AMETHYST Award

Provide a rationale. What could potentially set you apart from other applicants? What research, professional skills development and training opportunities offered by the AMETHYST program are of interest to you?

Applicant Support

Each application for admittance into the AMETHYST Program should be accompanied by letters of support.
Minimum 1, maximum 3.

Application Support Letter Form.

Please ensure your support letters are delivered to:
Mr. Trevor Armstrong
Office: WE1002
Alberta Water and Environmental Science Building
4401 University Drive
Lethbridge, Alberta, Canada
T1K 3M4

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