MITACS RESEARCH INTERNSHIP FINANCE DEPARTMENT
Graduate S
tudent Approval Form
________________________ ____________________________________________________ ________________________
Date Faculty of Department AAU Approval Required
Surname
Grantee Approval
Account Number
(Fund/Department/
Program or Project Account)
Natural Account
Number
(Canadian or
International)
Accidental Injury
Coverage Cost
Total Research
Stipend
(Lump Sum minus
Accidental Injury
Coverage)
Start/End Date of
the internship
(MM/DD/YYYY)
Given Name
Student Number
Employee Number
1
Print
81330
(Canadian)
81330
(International)
$4.20
(coverage duration
May 1
st
to April 30
th
)
Signature
2
Print
81330
(Canadian)
81330
(International)
$4.20
(coverage duration
May 1
st
to April 30
th
)
Signature
3
Print
81330
(Canadian)
81330
(International)
$4.20
(coverage duration
May 1
st
to April 30
th
)
Signature
4
Print
81330
(Canadian)
81330
(International)
$4.20
(coverage duration
May 1
st
to April 30
th
)
Signature
NOTE: This form should only be submitted after approval has been received from MITACS regarding the industry project, and the corresponding grant account has been generated.
All training listed below must be submitted with this form prior to the start of the student’s placement with the industry partner.
As the academic supervisor for this MITACS research internship, please verify the completion of the following by checking the boxes of the below requirements:
I verify I am the academic supervisor for this approved MITACS research internship and the student provided with this internship is a Masters/PhD student.
I verify the student is aware that the cost of the Accidental Injury Coverage will be deducted from the research stipend.
I have attached the confirmation training email (student to provide printed email confirmation for each training) marking the completion of the below training:
o Health & Safety Orientation: http://www1.uwindsor.ca/safety/healthandsafetyorientationworker
o WHMIS: http://www1.uwindsor.ca/safety/WHMIS
o Violence & Harassment Prevention: http://www1.uwindsor.ca/safety/system/files/WPVH%20Training%20April%202018.pdf
o Accessible Customer Service Training: http://www.uwindsor.ca/ohrea/57/accessibility-training
o AODA and Human Rights Training: http://www.uwindsor.ca/ohrea/61/aoda-and-human-rights-training
Academic Supervisor Signature: _______________________________ Date: _____________________________
All amounts paid from this internship are considered research income. This form must be completed in its entirety will all training confirmation emails attached in order to be
processed for payment.
Submit completed form and confirmation training emails to Human Resources. All inquiries should be directed to Human Resources at (519) 253-3000 ext. 2090
click to sign
signature
click to edit
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