Graduate Studies Awards Application Form

Fields denoted by an asterisk (*) are required.

Scholarships Awards

Scholarships Awards The Collip Medal Award Dr. William McGrath Scholarship for Research in Ophthalmology Morris Kroll Memorial Scholarship Drs. Madge and Charles Macklin Fellowship for Publication Drs. Madge and Charles Macklin Fellowship for Teaching & Research The Jonathan & Joshua Memorial Graduate Scholarship ($1,400) John P. Robarts Award for Innovative Medical Research The Cobban Student Award in Heart and Stroke Research Norman E. Nixon and Marie Ramo Nixon Award The Jonathan & Joshua Memorial Graduate Scholarship in Mental Health Research ($25,000) Dean’s Research Scholarship (MSc, $10,000) Dean’s Research Scholarship (PhD, $14,000) Other
Please specify other award
Personal Information
Name Name First Last
Student Number
Email
Phone Phone - ### - ### ####
Graduate Program
Start Date Start Date / MM / DD YYYY

(in current degree)
Supervisor(s)
Citizenship
Title of Thesis
If you are a current student, did you apply for OGS this year

If you are a current student, did you apply for OGS this year Yes No
Would you like the graduate studies office to use your OGS application?

Would you like the graduate studies office to use your OGS application? Yes No
Are you a new Western student, admitted in the last 9 months?

Are you a new Western student, admitted in the last 9 months? Yes No
Would you like the graduate studies office to use your admissions application?

Would you like the graduate studies office to use your admissions application? Yes No
Will this project be co-supervised by a clinician and a basic science researcher?

Will this project be co-supervised by a clinician and a basic science researcher? Yes No
Specify the role of each supervisor with regards to the project
Please explain in your own words, why you are the ideal candidate for this award:

[no more than a page is necessary/required]
Explain in your own words the rationale, hypothesis/objective, research plan and predicted significance of your research project (summary of research proposal):

[no more than a page is necessary/required]
Summarize all other demonstrated leadership, relevant life experience; teaching and community/volunteer work (include month and year):

[you must include month and year]
Academic Background (include all current and past degree programs with start and end dates):
List all Scholarships and other awards held or offered. Example: Ontario Graduate Scholarship (held 2009 - 2010), value $15,000

[include all awards, the amount and years offered/awarded]
List all academic, research and other relevant work experience (include start and end dates)

[including summer research experience]
Productivity (please use the formats for publication, abstracts, presentations below the text box)
The format for listing publications, abstracts and meeting presentations must be followed exactly as shown below. Cut and paste from your CV each citation into the appropriate document box in the application form. Include all authors in proper order; the complete title, journal, page numbers and year of publication. Also include latest available journal impact factor; citation numbers and your h-index if applicable. Finally a brief 3-4 line description of your role in completing the research and publication process is required for each publication listed. This is not required for abstracts or oral or poster presentations. Templates are as follows:

Examples of a publication:
Calder, M.D. Watson, P.H. & Watson A.J. 2011. Culture medium, gas atmosphere and MAPK inhibition affect regulation of RNA binding protein (RPB) targets during mouse preimplantation development. Reproduction 142: 689-698. Impact Factor 3.555 My role was to assist with study design, research result analysis, paper drafting and submission; also in obtaining operating grant support to fund the study.

Example of Abstracts:
Bell CE, Watson AJ (2009) The expression of transcription actors SNAi1and SNAI2 throughout preimplantation development. Biol Reprod Sp p101

Example of a presentation:
From Zygote to Blastocyst: How we made it? 22nd UCLA symposium on InVitro Fertilization and Assisted Reproductive Technologies â Santa Barbara California July 12-14th 2009.
Referee Information

Please have your referee send their references by the deadline date specified in the application directly to Janelle Pritchard at jpritch7@uwo.ca
Referee #1 Name
Referee #1 Title
Referee #2 Name
Referee #2 Title

Graduate Studies Awards Application Form

Graduate Studies Awards Application Form

Personal Information

Referee Information