Centre interuniversitaire québécois de statistiques sociales (CIQSS)

CIQSS - QICSS

Quebec Inter-University Centre for Social Statistics

FRANÇAIS

2012 International Internship Scholarship offered by the QICSS and the FQRSC - Registration

   
  Incomplete forms will be eliminated.
   
  Mr.     Mrs.  
  Last name First name
 
     
  Date of birth
 
     
  Mailing Address (street, city, province or state, country)             
 
     
  Postal Code  
   
     
  Telephone - Office Telephone - Home
 
 
  Telephone - Cell (optional)
 
     
  E-Mail  
 
     
  Web Site (optional)  
 
     
  Are you a Canadian citizen or permanent resident?       Yes    No
     
  If you are an international student, indicate your country of origin   
     
     
     
  SECTION II : Academic Background  
     
  University or Affiliated Institution
 
     
  Department Faculty
 
     
     
  Universities Attended  
 
  1  
Name of current programme:
Institution:
Diploma:
Year of beginning of your programme

Year awarded (expected)
 
  2  
Name of programme:
Institution:
Diploma:

Year awarded(if applicable)
 
  3  
Name of programme:
Institution:
Diploma:

Year awarded(if applicable)
 
  4  
Name of programme:
Institution:
Diploma:

Year awarded(if applicable)
   
  Please send the complete university transcripts. Photocopies are accepted.
     
     
  Ph.D. thesis research topic  
 
  Director(s) of research
  Enter the name of your QICSS project and/or its number.   
     
     
  How did you hear about this grant
 
     
  I declare that the provided information in this form is complete, true and correct.
     
     
 
     
     

 

 

 

 

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