Bursary Application

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Bursaries

Which bursary are you applying for?*

Full Conference Travel Bursary

Full Conference Bursary

Fundamentals of Addiction Bursary

Personal Information

Name*

Email*

Phone*

Address*

Education

Academic Affiliation*

Program*

Supervisor/preceptor*

Questions

What do you hope to gain by attending the CSAM-SMCA Annual Conference?*

What is your relationship to the person you chose as a referee? What role has this person played in your interest in Addiction Medicine?*

Please give us an idea where you are in your career development. In an ideal world, what would your professional life look like five years from now?*

What involvement have you had with CSAM-SMCA in the past? What role do you envision playing in the future?*

Are you part of an under-represented group within the organization?*

Reference Letters

Select 2 professionals who know you in the context of your involvement in the field of addiction medicine to attest to your character, the quality of your work, and your interest in addiction medicine.

How do you wish to provide your reference letters?*

Upload Files

Provide Links

First Reference Letter*

Second Reference Letter*

Reference Letters*

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Accepted file types: pdf, doc, docx, txt, , Max. file size: 5 MB, Max. files: 2.

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Date*

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