2014 nanofellowship application form 1

Waterloo Institute for Nanotechnology Nanofellowship Application Form

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This form includes the following sections:

A. Personal Information

B. Program Information

C. Academic and Research History

D. Outline of Proposed Research (PDF)

E. Transcripts (PDF)

F. Reference Contact Information

A. PERSONAL INFORMATION

Family Name

Given Name(s)

Telephone Number

Email

UW Student ID If Applicable (8 Numbers)

Address #1

Address #2

City

State/Province

Country

Postal Code

CITIZENSHIP

Canadian Citizen Permanent Resident of Canada Other

Country of Citizenship

Country of Citizenship

B. CURRENT PROGRAM

Are you currently enrolled at the University of Waterloo? Yes No

If Yes, select your program and department from the drop down menus below:

If No, please provide your current program and the university’s details below:

Degree Program Degree Program

Department Department

Supervisor (If Applicable)

Institution

Supervisor’s Email

Country

State/Province

Start Date (mm/yy)

Anticipated Completion Date

Start Date (mm/yy)

Anticipated Completion Date

PROPOSED PROGRAM

Are you currently enrolled at Waterloo in your proposed program? If Yes, don’t complete this section.

Yes No

Proposed Degree Program Proposed Department

Proposed Supervisor

Proposed Supervisor’s Email

Proposed Starting Date


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C. ACADEMIC AND RESEARCH HISTORY

Please provide the following information:

1. Academic Background

2. Academic Research and Relevant Work Experience

3. Awards and Scholarships

4. Publications and Presentations

5. Additional Achievements (Optional)

C1. ACADEMIC BACKGROUND

Provide degree(s) completed or in progress in chronological order. Indicate anticipated completion date for in progress degrees.

You may also provide any relevant certificate programs/training completed.

Degree Department Institution Country Cumulative

Average

Start Date (mm/yy)

Completed (mm/yy)

C2. ACADEMIC RESEARCH AND RELEVANT WORK EXPERIENCE

List job positions in reverse chronological order (most recent first). Indicate if the experience gained was part of a program of study.

Please include Job Title, Organization and Department and Period of time worked (in the format mm/yy-mm/yy) for all positions.

For research positions, additionally include Supervisor and Project Title.


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C2. ACADEMIC RESEARCH AND RELEVANT WORK EXPERIENCE (CONTINUED)

List job positions in reverse chronological order (most recent first). Indicate if the experience gained was part of a program of study.

Please include Job Title, Organization and Department and Period of time worked (in the format mm/yy-mm/yy) for all positions.

For research positions, additionally include Supervisor and Project Title.

If more room is required, ATTACH ADDITIONAL WORK EXPERIENCE HERE (PDF) (instructions on pg. 9)


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C3. AWARDS AND SCHOLARSHIPS

List awards and scholarships (and other honours) in reverse chronological order (most recent first.) Please indicate if the award is declined in brackets under the name of the award.

Date (mm/yy-mm/yy)

Name of Award or Scholarship Country

(if not Canada) Value

Level (eg: University, Regional,

National)

If more room is required, ATTACH ADDITIONAL AWARDS AND SCHOLARSHIPS HERE (PDF) (instructions on pg. 9)


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Please use the following format for publications:

Please include the full authorship as it appears/will appear in the original publication, with the applicant’s name in bold.

Make sure that full authorship, year, title, publication name and volume, and page numbers are included in your citations.

Publications and Presentations will be organized into the following categories:

a. Articles published, in press, and/or accepted in refereed journals

b. Articles submitted to refereed journals with submission number

c. Refereed conference proceedings and abstracts, and invited communications, reports, and book chapters

d. Non-refereed contributions such as technical reports, conference presentations, posters, and patents

C4. PUBLICATIONS AND PRESENTATIONS

List publications and presentations in reverse chronological order (most recent first) according to the categories given.

a. Articles published, in press, and/or accepted in refereed journals


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C4. PUBLICATIONS AND PRESENTATIONS (CONTINUED)


b. Articles submitted to refereed journals with submission number

c. Refereed conference proceedings and abstracts, and invited communications, reports, and book chapters


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C4. PUBLICATIONS AND PRESENTATIONS (CONTINUED)


d. Non-refereed contributions such as technical reports, conference presentations, posters, and patents

If more room is required, ATTACH ADDITIONAL PUBLICATIONS AND PRESENTATIONS HERE (PDF) (instructions on pg. 9)


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C5. ADDITIONAL ACHIEVEMENTS AND/OR SPECIAL CIRCUMSTANCES (OPTIONAL)

If you would like to report any additional achievements which do not fit into categories 1-4, you may do so here.

Examples: Leadership, volunteer experience, management etc.

You may also note any special circumstances.


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D. OUTLINE OF PROPOSED RESEARCH (Free Form, One Page)

Clearly describes the proposed research project that interests you and its relevance to nanotechnology. The originality and

relevance of the proposed research will be an important element of the evaluation. Focus areas in nanotechnology include,

but are not limited to:

Nanomaterials for applications in energy, electronics, environmental and health sectors

Nanoscale electronic, photonic and hybrid devices and systems

Nanotools, instrumentation and metrology

Nanotechnology in medical diagnosis, imaging, pharmaceutical delivery and tissue engineering

Special consideration will be given to students intending to pursue projects involving cross-disciplinary collaboration in

nanotechnology. Selection of recipients for the fellowships will be made by a committee chaired by the Executive Director

of the Waterloo Institute for Nanotechnology.

ATTACH YOUR (ONE PAGE) OUTLINE OF PROPOSED RESEARCH HERE (PDF) (Instructions at bottom of page)

E. TRANSCRIPTS

Please provide your transcripts for all degree programs you have obtained (Bsc, MSc, PhD). If you have already started

your proposed program of study at the time of application, you must also submit a transcript for this program of study along

with your application, regardless of the number of months completed in the program.

For non-UW students, please include one copy of the legend on the back of your transcript, to help the reviewers

understand the grading system at your university.

All of your transcripts must be provided in a single PDF file. Black and white scans will be accepted.

An official copy of the transcripts may be requested for verification in the review process.

ATTACH YOUR TRANSCRIPTS HERE (PDF) (Instructions at bottom of page)

Instructions for Attaching Files to the Application:

Attachments must be in PDF form.

Acrobat, or Adobe Reader version 10 or higher are required to attach documents. The latest version of Adobe Reader can

be downloaded at http://get.adobe.com/reader/

If you’re using Adobe Reader X (recommended) follow these instructions:

1. Click on “Comment” at the top right hand corner of the page

2. Under “Annotations” select the “Attach File” paperclip icon

3. Click in the appropriate space provided and select the file you would like to attach

If you’re using Adobe Acrobat or an older version of Adobe Reader, the same option can be found by selecting

Tools > Comment & Markup > Attach a File as a Comment (paperclip icon) from the top menu bar.

Your file should show up as a small paperclip icon in the box provided when it has been properly attached.

http://get.adobe.com/reader/


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Letters of Reference:

Applicants are encouraged to consider the full range of potential referees who could provide relevant evidence,

perspectives, and insight to support the review of your application. Please contact your referee early. It is the applicant's

sole responsibility to follow up with referees to ensure the two Letters of Reference are submitted prior to the deadline

indicated. You will receive a confirmation email stating the completeness of your application within three working days of

receipt of the required documents by the WIN offices.

If a referee informs you that the reference letter cannot be submitted within the set deadlines, please contact the WIN office

at [email protected] to arrange an approved late submission date or replace an alternate referee as soon as possible.

F. REFERENCE CONTACT INFORMATION

First Reference

Name

Title

Telephone Number

Email

Institution

Department

Address #1

Address #2

City

State/Province

Country

Postal Code

Second Reference

Name

Title

Telephone Number

Email

Institution

Department

Address #1

Address #2

City

State/Province

Country

Postal Code

End of Application

Application Check-list:

Application Form:

I have completed all relevant fillable fields of this Nanofellowships Application Form (Sections A-C)

I have written a ONE (1) page research proposal (PDF) and attached it (Section D)

I have combined all my transcripts into a single file (PDF) and attached them (Section E)

I have provided the contact information for my references (Section F)

References:

I am aware that it is my responsibility to ensure that my referees submit their reference letters prior to the

indicated deadline

mailto:[email protected]

2014 nanofellowship application form 1

Documents