Waterloo Institute for Nanotechnology Nanofellowship Application Form

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

Country of Citizenship

Other
Country of Citizenship

B. CURRENT PROGRAM Are you currently enrolled at the University of Waterloo? If Yes, select your program and department from the drop down menus below: Degree Program Department
Supervisor (If Applicable)

Yes
Degree Program Department
Institution

No

If No, please provide your current program and the universitys details below:

Supervisors 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, dont complete this section. Proposed Degree Program
Proposed Supervisor

Yes
Proposed Department
Proposed Supervisors Email

No

Proposed Starting Date

Waterloo Institute for Nanotechnology Nanofellowship Application Form

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.

Waterloo Institute for Nanotechnology Nanofellowship Application Form

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)

Waterloo Institute for Nanotechnology Nanofellowship Application Form

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)

Level Value
(eg: University, Regional, National)

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

Waterloo Institute for Nanotechnology Nanofellowship Application Form

Please use the following format for publications:
Please include the full authorship as it appears/will appear in the original publication, with the applicants 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

Waterloo Institute for Nanotechnology Nanofellowship Application Form

C4. PUBLICATIONS AND PRESENTATIONS (CONTINUED)
List publications and presentations in reverse chronological order (most recent first) according to the categories given.

b. Articles submitted to refereed journals with submission number

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

Waterloo Institute for Nanotechnology Nanofellowship Application Form

C4. PUBLICATIONS AND PRESENTATIONS (CONTINUED)
List publications and presentations in reverse chronological order (most recent first) according to the categories given.

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)

Waterloo Institute for Nanotechnology Nanofellowship Application Form

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.

Waterloo Institute for Nanotechnology Nanofellowship Application Form

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 youre 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 youre 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.

Waterloo Institute for Nanotechnology Nanofellowship Application Form

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 win@uwaterloo.ca 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

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