MEES/INRS
INTERNATIONAL MOBILITY AND SHORT STAYS OUTSIDE QUEBEC
PROGRAM
SCHOLARSHIP APPLICATION FORM
Graduate and Postdoctoral Studies Department
INRS
September 2018
Applicant:
Date of birth:
Year
Month
Day
Sex
Female
Male
Last name
First name
Town/City
Province
Postal code
Description and relevance of the activity: Duration:
Start :
Full location address:
End :
Activity supervisor:
Email address of the activity supervisor
Explain why you chose this location
2550 characters
How is the activity relevant to your INRS program?
1300 characters
Description of the activity
5050 characters
Name of the research director Research director’s signature
Name of the program director Program director’s signature
Declaration:
I, the undersigned, hereby declare that the information above is accurate and complete.
Signature Date
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signature
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signature
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signature
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