Your personal information

Surname:
First name:
Mailing address:

Telephone (home):
Fax:
Email address:

Gender:

I am fluent in:

• English
• French
• Other (please specify):

I prefer to receive materials and communicate in:

• English
• French

Your program of study

University:
Department:
Faculty:
City, Province:
Supervisor's name:
Supervisor phone number:
Supervisor email address:

What is your present level of studies (as of January 1, 2009)?

• Masters student
• Doctoral student
• Postdoctoral fellow
• Other (please specify):

Your research interests

Please write a brief description of your current research project and research interests. If applicable, include an explanation of how your work utilizes the concepts of gender and/or sex. If your work doesn't utilize the concepts of gender and/or sex, please explain why you're interested in adding this perspective to your work.
(500 words maximum):

Please use up to 5 key words or short phrases to describe your research areas of interest (for example, maternal health, HIV/AIDS, immigrant health, etc.)

Please use up to 5 key words or short phrases to describe your methodologies of interest (for example, grounded theory, longitudinal analyses, survey research, etc.)

Please tell us why you want to attend the 2009 IGH Summer Institute. What do you hope to get out of participating? What do you want to learn? How will it benefit your program of research?
(200 words maximum)

Is there anything else you'd like the selection committee to know about you?
(200 words maximum):

Residency requirement

Participants in the IGH Summer Institute are required to stay on campus at the University of British Columbia (Vancouver, BC) for the duration of the Summer Institute (June 23, 2009-June 26, 2009). Participants will stay in apartment-style residences at UBC. The residence is wheelchair accessible. IGH will make every effort to accommodate accessibility and other needs.

• I agree to adhere to the residency requirement.

Permission to share the information in this form

If you are selected to attend the IGH Summer Institute, we would like to share your name, contact information and information about your program of study with the other participants.

I give IGH permission to share my name, contact information, and information about my program of study with fellow Summer Institute participants should I be chosen to attend the 2009 IGH Summer Institute:

• Yes
• No

Required attachments

In addition to your application form, please send a copy of your current curriculum vitae (CV) and a copy of your current university transcript to Monica Penner by e-mail or fax (e-mail preferred).

Monica Penner
Executive Assistant, CIHR Institute of Gender and Health
Fax: 604-822-1622
E-mail: ea-igh@exchange.ubc.ca
Phone: 604-827-4470

Please note that a complete application package consists of:

• A completed application form
• A copy of your curriculum vitae (CV)
• A copy of your current university transcript

Incomplete applications will not be considered.