Fillable Form of Consent: NSERC USRA Summer 2021 (Brescia University College)

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Form of Consent: NSERC USRA Summer 2021 (Brescia University College)

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NSERC USRA Summer 2021
NSERC USRA Access to Academic Record Permission Form,
Faculty of Engineering Revised: Nov. 25, 2020
Access to Academic Record
Form of Consent
NSERC Undergraduate Student Research Awards (USRA)
I, ______________________________________________ give permission to the administrative
personnel in the Department/Faculty of Engineering at Western University to obtain a copy of my
“Academic Record*. This document will be used to determine my eligibility in compliance with
the guidelines of the NSERC Undergraduate Student Research Awards program to which I have
applied.
Student Number
Student Signature
Date (mm/dd/yyyy)
*Note: The Western “Academic Record” must be attached to the NSERC USRA application
submitted in the NSERC Online System for Western students. (Official transcripts are also
acceptable, but not required, for Western students. Official transcripts, plus legend, are
mandatory for students from other universities who are accepting an USRA at Western
University.)
The Academic Record must show marks through to Dec. 31, 2020.
Do not upload any other type of transcript/marks record with your application in the NSERC
Online System as it will not be accepted by NSERC.
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Form of Consent: NSERC USRA Summer 2021 (Brescia University College)

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Completed 17 February 2021

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