Submit your Application IBTN Summer School 2018 To submit your application to the Inaugural IBTN Summer School 2018, please complete the following form. Please note that all fields are required. We kindly ask that you review the Terms of the Application and Admission Process before completing this form as you will be asked to consent to these terms as part of the application process. ONLINE PRIVACY STATEMENT For reasons of privacy, this form does not offer a "Save and Continue" feature as this involves storing personal information on our servers without your express consent. Therefore, we recommend that you review the form and prepare the elements of your submission in advance, and return to complete the form once all your elements are ready. If you have comments or other questions concerning this application, please contact the IBTN Team at email@example.com Applicant InformationName* First Last Email* Address* Street Address Apartment City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth KoreaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Nationality*Please remember that applicants are responsible for making necessary arrangements related to any required travel or other visas.Status*Please indicate your current status. Please refer to the Terms of Application and Admission Process for more details. Select your statusMaster StudentPhD StudentPostdoctoral FellowNew InvestigatorFull-time Research AssociateDegree Program*Field of interest*Please indicate your main field of interest:University at which you are currently registered/employed*Supervisor's Name* First Last Date of appointment*Please indicate the date of your current faculty or research appointment (or equivalent)Applicant BackgroundPrevious Experience Designing Behavioural Interventions*Please indicate how much knowledge and hands-on experience you have in designing behavioural interventions: No knowledge or previous hands-on experienceBasic knowledge or minimal hands-on experienceSome knowledge or some hands-on experienceAdvanced knowledge or extensive hands-on experienceSelect the best descriptionPrevious Experience Conducting Behavioural Trials*Please indicate how much knowledge and hands-on experience you have in conducting behavioural trials: No knowledge or previous hands-on experienceBasic knowledge or minimal hands-on experienceSome knowledge or some hands-on experienceAdvanced knowledge or extensive hands-on experienceSelect the best descriptionCourse CreditsCourse Credit*Will you be applying to receive course credits for this program? Please refer to the Terms of Application and Admission Process for more details about course credits. YesNoTravel AwardsTravel Award*Would you like to apply for a travel award? Travels awards will be granted based on the pool of applicants, eligibility and available funding, and will be considered on a case-by-case basis. YesNoLetter of IntentUpload your Letter of Intent*Accepted file types: doc, docx, odt, ott, pdf, rtf.Maximum one (1) page (1.5 line spacing). This letter should cover your background, academic/professional areas of interest, motivation for attending the Summer School, and any other relevant information. Please refer to the Terms of Application and Admission Process for complete instructions about the Letter of Intent. CVUpload your CV*Accepted file types: doc, docx, odt, ott, pdf, rtf.Provide your most current CV (maximum 2 pages). It should include your background, previous work experiences and any other relevant information. Please refer to the Terms of Application and Admission Process for complete instructions about the CV format .Proof of StatusUpload proof of status*Please provide proof of your status as student, postdoctoral fellow, full-time research associate, or new investigator as outlined by the Terms of Application and Admission Process. Please refer to the Terms of Application and Admission Process for details about what type of document to be supplied based on your applicant status. Accepted file types: jpg, pdf, png, doc, docx, odt, ott, rtf.Additional InformationAdditional Information (optional)If you feel additional information could be relevant to your application, please include it here (maximum of 250 characters).ConsentApplicant Statement of Consent*By submitting your application, you hereby consent to sharing the information contained in your application with the IBTN for purposes of admission to the Inaugural IBTN Summer School and attendance at the 2018 IBTN Conference. You also confirm that you have read the Terms of Application and Admission Process and understand the terms relating to the offer of admission, registration rates and payment deadlines, tuition fees (if applicable), requests for withdrawal and reimbursement, and eligibility for travel awards and accommodations. You also attest that the information provided in your application is both complete and accurate. I have read and consent to the terms of this application and admission process. I attest that the information provided in my application is both complete and accurate. AcknowledgementsThe Inaugural 2018 Summer School is offered thanks to a Strategy for Patient-Oriented Research (SPOR) grant from the Canadian Institutes of Health Research (CIHR) with the participation of Concordia University, Université du Québec à Montréal, and CIUSSS-NIM-Hôpital du Sacré-Coeur de Montréal. Please review all fields before clicking the SUBMIT link below.