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The Mach-Gaensslen Foundation of Canada
Encouraging Research in Cardiology, Oncology, and Psychiatry
This is an agreement is between the Mach-Gaensslen Foundation of Canada
(Foundation)
And
_____________________________________________
(Grant Recipient)
that sets out reciprocal obligations between ourselves. The Foundation will provide the Grant Recipient
$ ______________ to perform research in some aspect of oncology, cardiology, or psychiatry in the
summer of ___________________. In return, the Grant Recipient will assist the Foundation to study
(i) the effects of student participation in a summer research program on a student’s medical career
choice and
(ii) participation in medical research throughout the student’s career.
This summer student research grant assistance will be provided to those selected students who agree with
completion of:
- a questionnaire before and after completion of the research project,
- a one-time program evaluation questionnaire,
- a consent to publish the student’s name and research title on the Foundation’s website,
- a research report and a Research Abstract (one-page) by October 30 in the year the research is carried out
- a follow-up questionnaire in the form of an on-line survey five years after completion of the summer student
research until cessation of practice.
Copies of the forms and questionnaires are appended to this agreement. The Grant Recipient allows and instructs
the University to provide future contact information (including e-mail address) to the Foundation for the purpose
of obtaining information about ongoing professional research activities.
Any information the Grant Recipient provides will be treated as confidential. No personally identifiable data will
ever be reported by the Foundation without the Grant Recipient’s explicit consent.
The Grant Recipient also warrants that the research to be carried out as a result of this funding meets the ethical
requirements of the Grant Recipient’s University’s ethical policies/guidelines.
Dated at: _____________________ this ______ day of __________________ 2______
________________________________ ________________________________
Grant Recipient Witness
Current
e-mail address: ______________________________________________
