Student Trainee Application

By submitting this form, the student agrees to have the requested information displayed on the ACN website (with the exception of their email address) and included in annual NSERC reports. If students prefer, they can submit the equivalent information directly to the Program Coordinator, without its inclusion in the website or in reports. Student Trainees are expected to provide the Program Coordinator with career information for 4 years after they graduate from the program.

Name:

Email:

Gender:

Male

Female

University + Department:

Degree, Program and Area:

Example: PhD, program in neuroscience

ACN Research Theme of most interest:

Developmental

Special Populations

Brain Imaging Analysis

Sensorimotor Integration

Sponsoring Mentor:

Date you began your degree program:

(month/year)

Date you expect to end your degree program:

(month/year)

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