CIMVHR Fellowship Application

Salutation

Prénom

Nom de famille

Désignation

Titre professionnel

Biographie courte (100 mots max.)

0 words. 100 words left.

Adresse

Ville

Province

Code postale

Pays

Téléphone

Extension

Mobile

Domaine de recherche (SVP entrer 1 à 5 mots-clés)

Information d’affiliation académique

Institution universitaire ou collégiale principale courante

Faculté universitaire ou collégiale principale

Département universitaire ou collégiale principale

École universitaire ou collégiale principale

Institution universitaire ou collégiale secondaire:

Information d’affiliation gouvernemental

Département Gouvernementale

Organisation

Informations sur les affiliations industrielles, philanthropiques ou autres

Affiliation industrielle ou de société à but lucrative

Affiliation philanthropique ou à but non lucratif

D’autre 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?

Social Links

Informations de connexion

Adresse courriel

Mot de passe

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