Centre interuniversitaire québécois de statistiques sociales (CIQSS)

CIQSS - QICSS

Quebec Inter-University Centre for Social Statistics

FRANÇAIS

2012 QICSS Grant Matching Programme - 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 not, indicate your country of origin   
     
     
     
  SECTION II : Academic Background  
     
  University or Affiliated Institution Student I.D.
 
     
  Department Faculty
 
     
     
  Universities Attended  
 
  1  
Name of current programme:
Level of study Masters      Ph.D.
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.
     
     
  Master or Ph.D. thesis research topic  
 
  Director(s) of research
  For Ph.D. Students, enter the name of your QICSS project and/or its number.   
     
     
  SECTION III : Financial Information (2011-2012)
     
  Grants, scholarships and fellowships obtained during graduate studies (if applicable)
  Organisation Amount
 
 
 
     
     
  Other income (research and teaching assistantships, etc.) expected during 2011-2012
 
 Source  Amount  Period
   
  Please send a proof of employment or job offer.
     
  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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