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Trainee's Full Name *

Student Number *

Student Status *

Year in the program: *

Department *

Supervisor *

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Recently Published Article *

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Article Date of Publication *

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Day

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Paragraph on the Significance of the Research *

Short C.V. of the trainee (biosketch format) *

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Name and ID of the first co-author if applicable: *

Name of the Journal *

Title of the Article Submitted *

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Department and University Information

FACULTY OF MEDICINE AND HEALTH SCIENCES

Room 637, McIntyre Medical Building
3655 Promenade Sir William Osler
Montreal, Quebec, Canada H3G 1Y6

T: 514-398-2497 | F: 514-398-8807