LAST NAME: FIRST NAME:
STREET ADDRESS: APARTMENT/UNIT #:
CITY: PROVINCE/STATE:
COUNTRY: POSTAL/ZIP CODE:
TELEPHONE: EMAIL:
COUNTRY OF CITIZENSHIP
NAME OF INSTITUTION:
PROGRAM OF STUDY:
DEPARTMENT:
FACULTY:
CITY: PROVINCE/STATE:
COUNTRY: POSTAL/ZIP CODE:
DEGREE NAME:
START DATE: END DATE
OR EXPECTED END DATE:
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This document contains both information and form fields. To read information, use the Down Arow from a form field.
CSA Group Graduate Research Scholarship
Application Form
A – PERSONAL INFORMATION
B – IMMIGRATION STATUS
CANADIAN PERMANENT RESIDENT INTERNATIONAL PROVIDE A COPY OF VALID STUDENT VISA OR STUDY PERMIT
C – EDUCATION PROFILE FROM MOST RECENT
DEGREE STATUS
COMPLETE IN PROGRESS INCOMPLETE APPLYING TO
C – EDUCATION PROFILE FROM MOST RECENTCONTINUED
NAME OF INSTITUTION:
PROGRAM OF STUDY:
DEPARTMENT:
FACULTY:
CITY: PROVINCE/STATE:
COUNTRY: POSTAL/ZIP CODE:
DEGREE NAME:
START DATE: END DATE
OR EXPECTED END DATE:
NAME OF INSTITUTION:
PROGRAM OF STUDY:
DEPARTMENT:
FACULTY:
CITY: PROVINCE/STATE:
COUNTRY: POSTAL/ZIP CODE:
DEGREE NAME:
START DATE: END DATE
OR EXPECTED END DATE:
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CSA GROUP GRADUATE
RESEARCH SCHOLARSHIP  APPLICATION FORM
2
START DATE: END DATE
OR EXPECTED END DATE:
NAME OF INSTITUTION:
PROGRAM OF STUDY:
DEPARTMENT:
FACULTY:
CITY: PROVINCE/STATE:
COUNTRY: POSTAL/ZIP CODE:
DEGREE NAME:
DEGREE STATUS
COMPLETE IN PROGRESS INCOMPLETE
DEGREE STATUS
COMPLETE IN PROGRESS INCOMPLETE
DEGREE STATUS
COMPLETE IN PROGRESS INCOMPLETE
csagroup.org
CSA GROUP GRADUATE RESEARCH
SCHOLARSHIP  APPLICATION FORM
3
D – AWARDS AND RECOGNITIONS FROM MOST RECENT
Year(s) Awarded Name of Scholarship, Award, Prize, etc. Funder Amount (if applicable)
E – EMPLOYMENT INFORMATION FROM MOST RECENT
POSITION:
ORGANIZATION:
START DATE
YEAR/MONTH:
END DATE
YEAR/MONTH:
POSITION:
ORGANIZATION:
START DATE
YEAR/MONTH:
END DATE
YEAR/MONTH:
POSITION:
ORGANIZATION:
START DATE
YEAR/MONTH:
END DATE
YEAR/MONTH:
POSITION:
ORGANIZATION:
START DATE
YEAR/MONTH:
END DATE
YEAR/MONTH:
POSITION:
ORGANIZATION:
START DATE
YEAR/MONTH:
END DATE
YEAR/MONTH:
POSITION:
ORGANIZATION:
START DATE
YEAR/MONTH:
END DATE
YEAR/MONTH:
csagroup.org
CSA GROUP GRADUATE RESEARCH SCHOLARSHIP  APPLICATION FORM
4
F – RESEARCH CONTRIBUTIONS
List publications under the following categories: 1) Peer-reviewed publications (e.g. journal articles, books, book chapters,
papers in conference proceedings); 2) non-peer-reviewed contributions; 3) contributions relating to industrially-relevant
R&D activities, patents and copyrights; 4) creative outputs; and 5) other relevant activities, if applicable.
csagroup.org
CSA GROUP GRADUATE RESEARCH SCHOLARSHIP  APPLICATION FORM
5
Have you previously engaged with a Standards Development Organization or do you have any other standards-related
experience? Explain. Note that this is not a requirement for the scholarship and will not be factored into the evaluation.
csagroup.org
CSA GROUP GRADUATE RESEARCH SCHOLARSHIP  APPLICATION FORM
6
G – STANDARDS-RELATED EXPERIENCE
H – AFFILIATIONS, MEMBERSHIPS AND OTHER ACTIVITIES
Activity Start Date End Date Description
I – SUMMARY OF PROPOSAL
Provide a brief summary of your proposal (max 300 words) in language that a lay audience can understand. This summary
may be made available to the public should the application be successful.
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CSA GROUP GRADUATE RESEARCH SCHOLARSHIP  APPLICATION FORM
7
J – STATEMENT OF RESEARCH
Provide a summary of the proposed research including an introduction of the issue, statement of purpose and a brief
description of methods. Proposals may be no longer than 2 pages excluding references. The proposal should clearly
describe the standards-related component of the research. Refer to the Application Instructions for further details.
csagroup.org
CSA GROUP GRADUATE RESEARCH SCHOLARSHIP  APPLICATION FORM
8
J – STATEMENT OF RESEARCH CONTINUED
csagroup.org
CSA GROUP GRADUATE RESEARCH SCHOLARSHIP  APPLICATION FORM
9
J – STATEMENT OF RESEARCH CONTINUED
csagroup.org
CSA GROUP GRADUATE RESEARCH SCHOLARSHIP  APPLICATION FORM
10
1. FULL NAME:
POSITION/INSTITUTION:
PHONE:
EMAIL:
2. FULL NAME:
POSITION/INSTITUTION:
PHONE:
EMAIL:
Scholarship Applicant
X
CSA GROUP GRADUATE RESEARCH SCHOLARSHIP – APPLICATION FORM
11
K – REFEREE INFORMATION
L – ATTACHMENTS CHECKLIST
SCHOLARSHIP APPLICATION FORM
PROOF OF CANADIAN CITIZENSHIP, PERMANENT RESIDENT, PROTECTED PERSON, OR STUDENT VISA
UNDERGRADUATE TRANSCRIPT(S)
GRADUATE TRANSCRIPT(S) (IF APPLICABLE)
SUPERVISOR LETTER OF SUPPORT
REFEREE LETTER 1 (SENT DIRECTLY TO SCHOLARSHIP@CSAGROUP.ORG FROM REFEREE)
REFEREE LETTER 2 (SENT DIRECTLY TO SCHOLARSHIP@CSAGROUP.ORG FROM REFEREE)
M – SIGNATURE AND DECLARATION
I certify that the information provided in this application is accurate and true. I understand that the information provided in
this application is subject to verification. If the information provided is found to be inaccurate, the applicant will not be eligible
for consideration. Should funding be provided prior to the determination of inaccurate information, the scholarship will be
revoked.
csagroup.org
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