Page 1 of 1 PROTECTED A WHEN COMPLETED
SEND A COPY TO THE AUTHORIZED INSTITUTIONAL OFFICE
RESPONSIBLE FOR ADMINISTERING THE INSTALMENT
Request for First Instalment or Reinstatement of
Award Paid by Canadian Institution
Part 1: AWARD HOLDER INFORMATION
Given name and initial(s)
Telephone number
T4A mailing address (if different)
Part 2: AWARD AND INSTITUTION INFORMATION
Committee number (NSERC only)
Research institution (CIHR only)
Part 3: INSTALMENT/REINSTATEMENT
(
I have provided a copy of my Notification of Decision to my
Scholarships Liaison Officer (SLO)
Award start date:
Documents attached, if required (CIHR only)
Award reinstatement date:
Signature of award holder:_________________________________________ Date:______________________________
Part 4: CONFIRMATION OF STATUS
To be completed by an SLO or equivalent official in the faculty of graduate studies or its equivalent
I confirm the award holder is registered as a full-time student or is engaged in full-time research.
I confirm the award holder has returned from an approved leave of absence and will be/is resuming studies/research for which funds
were awarded.
Name of official (print):______________________________________Title:_______________________________________________
Signature of official:_______________________________________Date:_________________________________________________
mm/dd/yyyy
mm/dd/yyyy
(mm/dd/yyyy)
(mm/dd/yyyy)