MITACS ACCELERATE/ELEVATE
APPOINTMENT AUTHORIZATION FORM
OVPRI – April 2019
This form must be completed and signed by the supervisor and submitted with the REQUEST FOR A RESEARCH
OR POST-DOC APPOINTMENT form if the appointment is funded through the MITACS Accelerate or Elevate
programs and the appointment will extend beyond the duration of each funding instalment.
By completing this authorization form, the supervisor acknowledges that they have fully vetted and approved the
industry partner listed in the Mitacs agreement; that it is their responsibility to maintain communication with the
industry partner, ensuring that the industry partner can continue to support the appointment throughout its
duration; and, that they will provide funding to support the appointment throughout its duration or cover any
costs associated with its early termination.
APPOINTEE: _____________________________________________________________________________
TITLE: ___________________________________________________________________________________
List the appointment title as it appears on the REQUEST FOR A RESEARCH OR POST-DOC APPOINTMENT form (e.g. Research Assistant,
Research Associate, Post-Doc, etc.).
APPOINTMENT DURATION: _______________ to _______________ WEEKLY WORK HOURS: _______
STIPEND/RATE OF PAY: ______________ BENEFITS:
N/A
Paid by Incumbent
Paid from Grant
List the appointment duration, weekly work hours, stipend/rate of pay, and benefit details as they appear on the REQUEST FOR A
RESEARCH OR POST-DOC APPOINTMENT form.
SUPERVISOR: ____________________________________________________________________________
DEPARTMENT: ___________________________________________________________________________
COMPANY: ______________________________________________________________________________
CONTACT: _______________________________________________________________________________
TITLE: ______________________________________________________________________
TELEPHONE: _________________________ EMAIL: _________________________________
MITACS PROGRAM:
Accelerate
Elevate
GRANT ACCOUNT: _____________________________________________________________
List the grant account established to hold the above-noted MITACS funding.
ALTERNATIVE GRANT ACCOUNT: __________________________________________________
List the grant account that will be charged in the event that MITACS funding is terminated.
I acknowledge that I have fully vetted the Industry Partner noted above.
I agree to provide funding to support this appointment through its duration or to cover any
costs associated with the early termination of this appointment from the alternative grant
account noted above.
Accepted:
_______________________________ __________________________________ ___________________
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