CIMVHR Scholarships Application
CIMVHR Scholarships Application
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Salutation
First Name
Last Name
Designation
Professional Title
Short Biography
(100 words max.)
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words left.
Address
City
Province
Postal Code
Country
Please choose a country:
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Croatia (Hrvatska)
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
France, Metropolitan
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and Mc Donald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland
Isle of Man
Israel
Italy
Ivory Coast
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kosovo
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia South Sandwich Islands
South Sudan
Spain
Sri Lanka
St. Helena
St. Pierre and Miquelon
Sudan
Suriname
Svalbard and Jan Mayen Islands
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania, United Republic of
Thailand
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States minor outlying islands
Uruguay
Uzbekistan
Vanuatu
Vatican City State
Venezuela
Vietnam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna Islands
Western Sahara
Yemen
Zaire
Zambia
Zimbabwe
Phone
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I am a(n):
(Please choose all that apply)
Researcher
Academic
Government
Independent
Student
Post-doctoral fellow
Doctoral student
Master’s student
Undergraduate student
Department of National Defence
Canadian Armed Forces
Veteran
War Service
Canadian Armed Forces
Royal Canadian Mounted Police
Military family member
Public safety personnel
Canadian Border Services
Canadian Security Intelligence
Correctional Officers
Dispatchers
Emergency Call Centre Operators
Firefighters (including volunteers)
Municipal Police Officers
Provincial Police Officers
Royal Canadian Mounted Police
messages.cap_parmedic
Emergency Medical Technician (EMT)
EMT Personnel
Administrator
Policy maker
Health care professional
Philanthropist
Industry representative
Political leader
Other
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
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/college you are representing:
n/a
Anglia Ruskin University
Bar-Ilan University
British Columbia Institute of Technology
Brock University
Carleton University
Central Michigan University
Concordia University
Dalhousie University
École de technologie supérieure
Gallipoli Medical Research Institute
Guelph University
King's College London
Lakehead University
Laurentian University
Lethbridge University
McGill University
McMaster University
Memorial University
Mount Saint Vincent University
Nipissing University
Penn State University
Queen's University
Royal Military College of Canada
Royal Roads University
Ryerson University
Saint Mary's University
Simon Fraser University
Syracuse University
Trinity Western University
Uniformed Services University
Université à Chicoutimi
Université De Moncton
Université de Montréal
Université de Sherbrooke
Université du Québec à Montréal
Université du Québec à Trois-Rivières
Université du Québec en Outaouais
Université Laval
University of Adelaide
University of Alabama
University of Alberta
University of British Columbia
University of Calgary
University of Guelph
University of Lethbridge
University of Manitoba
University of New Brunswick
University of Ontario Institute of Technology
University of Otago
University of Ottawa
University of Pittsburgh
University of Prince Edward Island
University of Queensland
University of Regina
University of Saskatchewan
University of Sherbrooke
University of Southern California
University of Toronto
University of Victoria
University of Waterloo
University of Windsor
Western University
Wilfrid Laurier University
York University
Other University
Primary University or College Faculty
Primary University or College Department
Primary University or College School
Current Secondary University or College Affiliation
Please specify:
n/a
Anglia Ruskin University
Bar-Ilan University
British Columbia Institute of Technology
Brock University
Carleton University
Central Michigan University
Concordia University
Dalhousie University
École de technologie supérieure
Gallipoli Medical Research Institute
Guelph University
King's College London
Lakehead University
Laurentian University
Lethbridge University
McGill University
McMaster University
Memorial University
Mount Saint Vincent University
Nipissing University
Penn State University
Queen's University
Royal Military College of Canada
Royal Roads University
Ryerson University
Saint Mary's University
Simon Fraser University
Syracuse University
Trinity Western University
Uniformed Services University
Université à Chicoutimi
Université De Moncton
Université de Montréal
Université de Sherbrooke
Université du Québec à Montréal
Université du Québec à Trois-Rivières
Université du Québec en Outaouais
Université Laval
University of Adelaide
University of Alabama
University of Alberta
University of British Columbia
University of Calgary
University of Guelph
University of Lethbridge
University of Manitoba
University of New Brunswick
University of Ontario Institute of Technology
University of Otago
University of Ottawa
University of Pittsburgh
University of Prince Edward Island
University of Queensland
University of Regina
University of Saskatchewan
University of Sherbrooke
University of Southern California
University of Toronto
University of Victoria
University of Waterloo
University of Windsor
Western University
Wilfrid Laurier University
York University
Other University
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
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