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F202-1_e - Optional Information(Refer toThe Access to...

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OTHER INFORMATION FORM 202 Application for an Undergraduate Student Research Award PART I. Personal Data To be completed by student ACADEMIC BACKGROUND (including ongoing postsecondary degree) Date Year and month of expected degree completion Reference No. Family name of student Given name Personal Identification no. (PIN) Department Institution Name of discipline Degree I hereby agree to abide by NSERC regulations governing awards, Program Guide for Students and Fellows. as described in the NSERC SIGNATURE (Refer to instructions "What does my signature on the application mean?") Permanent mailing address (if differerent from current address) Current address If current address is temporary, indicate leaving date Telephone number at permanent mailing address Telephone number at current address E-mail address Language of correspondance Citizenship Canadian citizen Permanent resident (indicate date of landing as stated on official immigration document)
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Unformatted text preview: Optional Information (Refer toThe Access to Information Act and The Privacy Act) English French Designated group Gender Male Female Aboriginal SCHOLARSHIPS AND OTHER AWARDS RECEIVED (start with most recent and include NSERC awards) How many academic terms will you have completed towards your degree program when this award is held? At the time of application, are you attending university Have you ever applied to NSERC in the past? full time? part time? Yes No (yyyy/mm - yyyy/mm) Period held Name of award Location of tenure Initial(s) of all given names Student Form 202-1 (200 9 ) Personal information collected on this form and appendices will be stored in the Personal Information Bank for the appropriate program. PROTECTED WHEN COMPLETED Version française disponible...
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