CIMVHR Scholarships System

Salutation

First Name

Last Name

Designation

Professional Title

Short Biography (100 words max.)

0 words. 100 words left.

Address

City

Province

Postal Code

Country

Phone

Extension

Mobile

Area(s) of research (Please provide 1 to 5 keywords or phrases. Each keyword or phrase on a new line.)

Academic Affiliation Information

Current Primary University or College Affiliation

Primary University or College Faculty

Primary University or College Department

Primary University or College School

Current Secondary University or College Affiliation

Government Affiliation Information

Government Department

Government Organization

Industry, Philanthropic or Other Affiliation Information

Industry Affiliation / For Profit Organizations

Philanthropic Affiliation / Not for Profit Organizations

Other Affiliation

Self-identification

The self-identification information in this section is for internal use only. You can modify your self-identification information at any time from your user profile screen.

How do you self-identify in terms of gender:

Man

Woman

Other:

I do not identify within the gender binary

I prefer not to disclose information concerning my gender

Do you self-identify as a member of the LGBTQ+ community?

Yes

Prefer not to respond

Do you self-identify as an Indigenous/Aboriginal person?

Yes

Prefer not to respond

Do you identify as a person with a disability?

Yes

Prefer not to respond

What language(s) are you fluent in?

Do you speak an Indigenous language?

Yes

Prefer not to respond

Social Media Contact

Are you willing to have your research highlighted in CIMVHR materials or on social media?

Yes

Disclaimer: CIMVHR will not promote you or your non-CIMVHR research without contacting you in advance for approval.

Would you be willing to be contacted as a subject matter expert in your field for media inquiries?

Yes

CIMVHR Event Interest

Which Canadian cities would you be willing to travel to attend CIMVHR events?

Password

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