• IPNA Clinician Scientist Academy

    IPNA Clinician Scientist Academy

    Applicant Form
  • Which of the below best describes your current career stage?*

  • EQUITY, DIVERSITY, AND INCLUSION SELF DECLARATION:

  • IPNA is committed to increasing representation and ensuring equal opportunities for its members. All IPNA mentors, learners and applicants are requested to submit this self-identification form. Each person may choose not to self-identify by selecting the option "I prefer not to answer" without consequence.

  • What is your biological sex (assigned at birth)?*
  • What best describes your current gender identity?

  • Do you identify as a person with a disability?

    A person with a disability is a person who has along-term or recurring physical, mental, sensory, psychiatric or learning impairment and:

    • Who considers themselves to be disadvantaged inemployment by reason of that impairment, or
    • Who believes that an employer or potential employer is likely to consider them to be disadvantaged in employment by reason of that impairment; and
    • Includes persons whose functional limitations owing to their impairment may have been accommodated in their current job or workplace.
  • *
  • Which describes best your ethnic background?*

  • APPLICATION DETAILS

  • Please answering the following questions in less than 250 words per question.

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  • DOCUMENTS FOR UPLOAD

  • Kindly attached the following documents for upload:

  • Kindly attach your CV (format acceptable to your local institution) in a PDF format.

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  • LETTER OF SUPPORT:

    A maximum 1 page letter signed by the primary supervisor (for PhD students, Postdocs) or Department Head or Division Head (for Early Career faculty members) describing:

    Their commitment towards the candidate's research training and endorsement of the candidate. The space, facilities and personnel support, including the interdisciplinary nature of the research environment in the local institution. How will they ensure that the learner is able to fully participate in the IPNA scientist academy, one day in person meeting, and provide support to complete the research study.

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  • IPNA MENTOR SUGGESTION

    As an IPNA scientist academy fellow, you will be assigned to IPNA mentors. Feel free to suggest a potential mentor in the below text box that you feel will be a good match. We will take these suggestions into consideration when assigning mentors. You can find the list of mentors HERE. 

  • DISCLOSURES, CONSENT, SIGNATURES

  • I confirm that myself, and my supervisor or Department Heador Division Head have discussed the submission of this application*
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