Please enable JavaScript in your browser to complete this form.CHECKLIST: A complete application package includes the following: Completed application form Applicant CV Signed signature page, emailed to info@canfasd.ca Letter of support from two references – letters must: Be submitted via email with applicant name in subject line from the individual’s personal email account (university account for Supervisor/Department Head) and contain their contact details, including title, department affiliation, and university, in English or French Speak to the applicant’s research activity and potential within the field of FASD, positive or promising aspects of the applicant’s character, and examples of achievements Applicant InformationName *FirstLastCurrent position: *Master's studentDoctoral studentPost-Doctoral FellowEarly Researcher (within 3 years of Faculty appointment)University: *Department: *Address (home or university): *Address Line 1Address Line 2CityState / Province / RegionPostal CodeCanadaAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryPhone *University email: *EmailConfirm EmailAlternate email: *EmailConfirm EmailApplicant CV * Click or drag a file to this area to upload. Please upload your Curriculum VitaeReferencesProvide two letters, at least one of which must be from a current or recent (within 3 years) academic supervisor or Department head. The second letter may be from a recent academic supervisor/Department head or a community partner or stakeholder who has played a significant role in your work (e.g., project partner, participant, individual with lived experience, etc.): Reference 1:Name *FirstLastUniversity *Department *City *Province *Phone *Email *EmailConfirm EmailReference 2:Reference 2 is a *Academic Supervisor orCommunity Partner/StakeholderName *FirstLastUniversityDepartmentCity *Province *Phone *Email *EmailConfirm EmailProject DetailsTitle of Project *Research Key Words *Up to 10 keywordsArea of FASD studied *PreventionDiagnosisInterventionChild WelfareJusticeOtherArea of FASD studied, if Other *Location of Project *CityProvince *Province/TerritoryProject Overview *Using simplified language understandable to a layperson, provide a general, one-paragraph description of the research project that was undertaken. (250 words maximum) Applicant Statement of Interest *Describe why you are interested in applying for the Dr. Sterling Clarren FASD Research Award and how this experience will benefit your research career. (250 words maximum)Research Project Details *Provide an overview of your project, including the objectives or research questions, detailed methodology, and findings. (750 words maximumKnowledge Translation *Provide a clear and detailed description of how study findings have been and/or will be translated to knowledge users. (250 words maximum)Project Innovation and Impacts *Describe how your project is innovative or novel, advances the field, and inspires future research. Also comment on the ways in which your findings impact the lives of people with FASD, their families, and/or communities. (250 words maximum)Dr. Sterling Clarren FASD Research Award Memorandum The participants listed above have agreed to the terms of the Dr. Sterling Clarren FASD Research Award, as outlined in the application and in the Award Criteria. Upon approval, CanFASD shall notify the recipient and forward funds to them via electronic bank transfer or mailed cheque. Please note that the information above, including the title of the project, description of research project, name of applicant, name of Supervisor(s)/Department Head and involved universities may be posted on www.canfasd.ca and used by CanFASD to publicize the Dr. Sterling Clarren FASD Research Award. Please download and complete memorandum and signature page, and email to info@canfasd.ca after submitting the application. How did you first hear about the Award? *Notification from your University Department or at the University (bulletin board posting, email communication, newsletter, University website)From a colleague/classmateCanFASD social mediaContacted by a CanFASD representativeOtherNameSubmit