Broaden your scope program form - Quebec Pain Research Network

Information about the candidate

I certify to be a member of the Quebec Network of Junior Pain Investigators*

Yes

Applicant's email*

Name of the applicant*

First Name Last Name

Scientific field*

Main affiliation*

Laboratory name*

The Quebec laboratory in which you work in

Your director's name*

The director must be a regular member of the QPRN

Director's email*

Visited laboratory

Name of the visited laboratory*

Visited laboratory

Hosting laboratory director’s name*

Location*

City Country

Visit start date

Visit duration

Please indicate the duration in weeks

Research project

Project's title*

Project type*

Introduction*

200 words max

Realistic goals for the training*

200 words max

Methods and skills to acquire*

200 words max

Expected results*

200 words max

Necessity of the training

Skills to acquire that are unavailable in Quebec*

200 words max

Interest in getting that skill out of Quebec even if available in Quebec

200 words max

Expectations*

200 words max

Implications for your current PhD project or postdoc*

200 words max

Budget

Please attach your budget as a table as an attachment. Include a detailed description of the planned expenditures (outputs) as well as other sources of funding (inputs)

Budget*

Max. file size: 5 MB.

Biosketch

A Biosketch is a document of a maximum of four pages describing : 1. Academic background, 2. Work experiences, 3. Prizes and distinctions, 4. Received grants, 5. Publications in peer-reviewed journals for the past five years, 6. Any other contribution

Student's biosketch*

Max. file size: 5 MB.

Internship supervisor-collaborator biosketch*

Max. file size: 5 MB.

Recommendation letters

Director’s recommendation letter*

Max. file size: 5 MB.

Hosting director’s recommendation letter*

Max. file size: 5 MB.

Privacy policy*

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