To be completed by all postdoctoral researchers, graduate students and other trainees (including undergraduate, high school, co-op, volunteer, and summer students) engaging in research at one of the following UHN institutes: KITE/TRI, Krembil Research Institute, McEwen Stem Cell Institute, Princess Margaret Cancer Centre, TECHNA, TIER or Toronto General Hospital Research Institute. For questions please contact the UHN Office of Research Trainees (ORT). Current Date * MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year First Name * Last Name * Employee ID Number (ie. 555555) Preferred given name Preferred Email Address * UHN Research Email address UHN Research Institute * - Select -Toronto Rehab Institute (KITE)Krembil Research Institute (Krembil)McEwen Stem Cell Institute (McEwen)Princess Margaret Cancer Centre (PM)TECHNATIERToronto General Hospital Research Institute (TGHRI)Other If selected 'Other' for Research institute, please describe Position * - Select -High school research studentUndergraduate research studentGraduate student – MSc (Including those with option to reclassify to PhD)Graduate student – PhD (Direct entry or have reclassified)Postdoctoral ResearcherMedical studentClinical research fellowSummer studentOther If selected 'Other' for Position, please describe Please indicate the University you are affiliated with for your Graduate Studies. * - Select -University of TorontoRyerson UniversityYork UniversityUniversity of WaterlooMcMaster UniversityWestern UniversityUniversity of GuelphQueens UniversityOther If answered 'Other' for graduate university, please describe Please indicate Graduate Studies Department * - Select -BiochemistryDalla Lana School of Public HealthDentistry, Faculty ofImmunologyInstitute of Biomaterials and Biomedical Engineering (IBBME)Institute of Medical SciencesLaboratory Medicine & PathobiologyMedical BiophysicsMolecular GeneticsNursing, Faculty ofNutritional SciencesOccupational Science and Occupational TherapyPharmaceutical SciencesPharmacology & ToxicologyPhysical TherapyPhysiologyRehabilitation Sciences InstituteSpeech-Language PathologyOther If answered Graduate Studies Department 'Other', please describe Are you a rotation student? * - Select -YesNo Please indicate type - None -Summer StudentWork-studyCo-opVolunteerOther If answered type 'Other', please describe Are you coming to UHN as part of a specialized summer student program? * - Select -YesNo Select your program name * BiochemistryCellular and Biomolecular ResearchCharles Hollenberg Summer Studentship ProgramComprehensive Research Experience for Medical Students (CREMS)Institute of Biomaterials & Biomedical EngineeringImmunologyInstitute of Medical ScienceLaboratory Medicine & PathobiologyMedical BiophysicsMolecular GeneticsRadiation MedicineResearch Application Support Initiative (RASI)Summer Student Clinician Scientists ProgramToronto General Hospital Multi-Organ Transplant Student Research Training ProgramOther If answered program 'Other', please describe I am a Canadian Citizen or Permanent Resident - None -YesNo Supervisor First Name * Supervisor Last Name * Co-Supervisor First Name Co-Supervisor Last Name Assignment Start date * MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year Estimated End date MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year Note: You must follow UHN offboarding protocol (internal connection required) upon your departure Will you have patient contact? Yes No Unsure Do you have an ORCID? Yes No Intend to register (Open Researcher and Contributor Identification is a unique identifier that distinguishes you from other researchers. Visit ORCID for more information.) Enter ORCID ID number How did you hear about research at UHN? Academics Please check all that apply and input the associated information Additional Degrees/Training (Completed or In Progress) Bachelor's Degree Master's Degree MD or Equivalent PhD Degree Other Education Please click here to input Bachelor's Degree Information Name of Institution Department or Faculty (if applicable) Program of Study (if applicable) Supervisor Name (if applicable) Number of Years Thesis Requirement Yes No Completed Yes No Year Completed Please click here to input Master's Degree Information Name of Institution Department or Faculty (if applicable) Program of Study Supervisor Name (if applicable) Number of Years Thesis Requirement Yes No Completed Yes No Year Completed Please click here to input Medical Doctorate (MD) or Equivalent Information Name of Institution Department or Faculty (if applicable) Program of Study (if applicable) Supervisor Name (if applicable) Number of Years Thesis Requirement Yes No Completed Yes No Year Completed Please click here to input Doctor of Philosophy (PhD) Degree Information Please submit PhD Degree Info Name of Institution Department or Faculty (if applicable) Program of Study (if applicable) Supervisor Name (if applicable) Number of Years Thesis Requirement Yes No Year Completed Completed Yes No Please click here to input Other Education Information Name of Institution Department or Faculty (if applicable) Program of Study (if applicable) Supervisor Name (if applicable) Number of Years Thesis Requirement Yes No Completed Yes No Year Completed By submitting this form, I confirm that the information provided on this form is correct. I agree to become familiar with and abide by all policies of the research Institute, available through the Policies & Procedures database located on the UHN Intranet. I will inform the Office of Research Trainees (ORT) immediately should there be any changes to this information. By submitting this form, I consent to the collection, use and disclosure of my personal information by the ORT during the course of my involvement as a trainee at UHN. Note: New trainees MUST attend the New Employee Orientation (for UHN employees) or Research Orientation (for individuals not paid by UHN but contributing to UHN Research) in addition to the other mandatory training requirements. For questions please contact ort.admin@uhnresearch.ca. Leave this field blank CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. What code is in the image? * Submit
