QICSS Entrance Scholarship

Last Name

First Name

Full Home Address (civic number, street, city, postal code)

Telephone (work)

Telephone (home)

Telephone (cell)

University

Department

Major field of study

Level of studies

Masters

Ph.D.

Year started degree program

Anticipated completion year

Subject of masters thesis or doctoral dissertation

Name of research director

Email address of research director

Please provide your QICSS project number

How did you hear about this scholarship?

I intend to complete my masters thesis or doctoral dissertation using a QICSS-registered project

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