Student Name:
Student ID Number: Program:
Complete Address:
Telephone: Email:
Proposed Supervisor : Dept.:
Proposed Area of
Currents Degrees Completed/In Progress:
List your degree and diplomas starting with the most recent or in progress
Attach official University transcripts from each location of study. (University of Guelph transcripts are not necessary.)
Degree University Period of Study
Additional Research Experience:
Supervisor: Period Covered:
Supervisor: Period Covered:
Supervisor: Period Covered:
Anticipated Start Date*:
* You must have submitted your online PhD application
to be considered for this award.
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Candidates must ask two individuals to provide an assessment on their behalf. Give the name of the individuals whose
assessment accompanies this application. Sealed letters with the referee's signature on the back of the envelope must be attached.
Name Position Held Institution/Location
Proposed Area of Research
This section should be completed in collaboration with the proposed supervisor. Both the candidate and the proposed
supervisor must sign on page 4 to confirm the accuracy of the proposed training program.
Project Title:
Descriptive Summary of the research project. Include specific hypothesis of research and describe the candidate's role in the
project. Should be written in layman's language. If more space is required to describe your research project, one additional page
may be inserted immediately following this page.
b) Interruptions in Scientific Career
If there has been an interruption in pursuit of your scientific career either in or subsequent to training, provide an explanation.
List the period and the reason for the interruption.
Position Institution/Organization
Start Date
End Date
Academic and Professional Experience
Begin with your most recent (includes academic, industrial, public sector)
Date Awarded:
Date Awarded:Awarding Organization:
Type of Award:
Awarding Organization:
Type of Award:
Honours and Awards
Provide as much detail as possible on the type of award, including salary and training awards, date awarded and awarding agency.
Type of Award:
Awarding Organization: Date Awarded:
Type of Award:
Awarding Organization: Date Awarded:
Type of Award:
Awarding Organization: Date Awarded:
Date Awarded:Awarding Organization:
Type of Award:
Protection of Privacy:
We are committed to protecting your privacy. Personal information that you provide to the University is collected under the authority of the University of Guelph
Act (sections 11 & 13), 1964. It is collected for the purpose of administering: admissions; registration; academic programs and services; university-related
student activities; activities of student societies; financial assistance and awards; graduation and university advancement; and for the purpose of statistical
reporting to government agencies. At all times it will be protected in accordance with the Freedom of Information and Protection of Privacy Act (FIPPA). If you
have questions about the use and disclosure of this information call the Office of Graduate Studies at (519) 824-4120 ext.56833 or review our website at
Official transcripts for each area of study and 2 referee letters, all sealed and signed, should be included.
Proposed Supervisor
The undersigned agree that this accurately describes the program proposed.
b) List the publications and presentations in each of the categories provided in over the course of your career. Start with the
most recent. For each publication list the full authorship as it appears in the original publication, year, title, name and volume of
the publication and the first and last page numbers. For the presentation of external and internal abstracts, and the continuing
education presentations provide information on the location, meeting, audience and date. If more space is required one
additional page maybe inserted immediately following this page.
Published / In Press Submitted
Refereed Research Paper
Case Reports
Book Chapters
Abstracts/Research Papers
Provincial or National
Abstracts/Research Papers
(International Meeting)
Internal Research
Continuing Education
a) Indicate the number of publications (as sole or coauthor) in each category (excluding manuscripts in progress) over the course
of your career to date.
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