LHRD Trainee Form

Fields denoted by an asterisk (*) are required.

Contact Information

Please provide your contact information:
Name Name First Last
Email Address
I am currently:

I am currently: PhD Student MSc Student BSc/BMSc Student Medical or Dental Student Research Associate/Staff Resident/Clinical Fellow Postdoctoral Fellow/Associate Other (Specify) Other (Specify)
I am in year

I am in year 1 2 3 4 5 Other Other
Supervisor(s):
Department
Affiliations (check all that apply)

Affiliations (check all that apply) Western University Lawson Health Research Institute (includes any health research at London Health Sciences Centre and/or St. Joseph’s Health Care London) Faculty of Health Science (Nursing, Kinesiology, Rehabilitation Therapy, and Occupational Therapy) Schulich School of Medicine & Dentistry Robarts Research Institute Other Other
Request (check all that apply):

Request (check all that apply): Poster only Poster or Oral

Please note that some abstracts might be selected for an oral presentation
Abstract Title
Abstract:
Abstract should be up to 300 words describing Background/Introduction, Methods, Results (if applicable) and Conclusions.
Maximum of 300 words allowed. Currently Entered: 0 words.
Select Research Theme:

Possible to Rank order up to 5
First Choice (select one)
Second Choice (select one)
Third Choice (select one)
Fourth Choice (select one)
Fifth Choice (select one)