Sterling Clarren FASD Research Award Application 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 at least one reference – 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 Information

Name *

First

Last

Current position: *

Master's student
Doctoral student
Post-Doctoral Fellow
Early Researcher (within 3 years of Faculty appointment)

University: *

Department: *

Address (home or university): *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone *

University email: *

Email

Confirm Email

Alternate email: *

Email

Confirm Email

Are you an individual member (Professional or Personal) of CanFASD? *

Yes
No

What email did you use for your membership? *

University email
Alternate email
Other

Member Email Address *

Enter the email address you used to sign up for a CanFASD individual membership.

Applicant CV *

Click or drag a file to this area to upload.

Please upload your Curriculum Vitae

References

Provide at least one letter, the first of which must be from a current or recent (within 3 years) academic supervisor or Department head. The second letter is optional, and 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 *

First

Last

University *

Department *

City *

Province *

Phone *

Email *

Email

Confirm Email

Reference 2:

A second reference is optional.

Reference 2 is a

Academic Supervisor or
Community Partner/Stakeholder

Name

First

Last

University

Department

City *

Province

Phone

Email

Confirm Email

Project Details

Title of Project *

Research Key Words *

Up to 10 keywords

Area of FASD studied *

Area of FASD studied, if Other *

Location of Project *

City

Province *

Province/Territory

Project 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 maximum

Knowledge 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/classmate
CanFASD social media
Contacted by a CanFASD representative
Other