NSERC AMETHYST Application Form You must have JavaScript enabled to use this form. Logo Personal Information Family Name Given Name Initial(s) UofL ID Social Insurance Number Personal Information Addresses Addresses Current Address Permanent Mailing Address (If different from current address) If current address is temporary, indicate leaving date Telephone number Telephone number at permanent mailing address Fax Number Primary e-mail address Personal Information Citizenship 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 Personal Information Signature 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. - Select -AcceptDecline Personal Info - Date Academic Background First Degree Degree (most recently completed or currently in progress) Discipline (major) Department, Institution and Country Month and Year started Month and Year awarded/expected Second Degree Degree Discipline (major) Department, Institution and Country Month and Year started Month and Year awarded/expected Third Degree Degree Discipline (major) Department, Institution and Country Month and Year started Month and Year awarded/expected Academic, Research and Other Relevant Work Experience Academic, Research And Other Relevant Work Experience Instructions 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) End Period (YYYY/mm/dd) 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) End Period (YYYY/mm/dd) 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) End Period (YYYY/mm/dd) 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) 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 No SGS Application Indicate the total number of months of graduate studies (master’s or doctoral) you have or will have completed as of December 31 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 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 Scholarships and Other AwardsPlease 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$) Level: Institutional, Provincial, National, International Type: Academic, Research, Leadership, Communication Location of tenure Start Period (YYYY/mm/dd) End Period (YYYY/mm/dd) Scholarship/Award 2 Name of award Value (per annum) (CND$) Level: Institutional, Provincial, National, International Type: Academic, Research, Leadership, Communication Location of tenure Start Period (YYYY/mm/dd) End Period (YYYY/mm/dd) 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) End Period (YYYY/mm/dd) Thesis completed or in progress Thesis completed or in progress First Degree 1. Degree Supervisor and institution Date completed or expected (mm/yyyy) Title of thesis Second Degree 2. Degree Supervisor and institution Date completed or expected (mm/yyyy) Title of thesis Sumarry of thesis most recently completed or in progress 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 Reference Form 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 ArmstrongOffice: WE1002Alberta Water and Environmental Science Building4401 University DriveLethbridge, Alberta, CanadaT1K 3M4
