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CPIN Student Completion Form

CPIN graduate students who have completed both their home department and CPIN trainee requirements must fill in the below completion form. 

Click here to view the CPIN Student requirements.

To ensure that the form has been received by us, please wait for a confirmation message upon submission. We recommend Google Chrome or Mozilla Firefox to fill the form.

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Graduating Student Information
Student Name:
Student Number:
E-mail Address:
 
CPIN would like to keep in contact with its Student Alumni for feedback to improve our program and in order to support our graduates. Please provide your permanent email address for this purpose:
 
Home Department:
Program:
Program Start Date:
Pick date
Program End Date:
Pick date
Supervisor's Name:
Supervisor's Email Address:
 
Thesis Title:
Please attach a copy of your Thesis Title page:
Completion of CPIN Program Requirements
Approved neuroscience course(s) completed:
Please attach a screen shot from ROSI showing that you have completed the CPIN course requirements:
Date(s) of CPIN Research Day Presentation(s) in DD/MM/YY format:
Distinguished Lectures and other lectures attended (name of speaker or date of lecture sufficient):
Other information
List of your Publications (Research papers, reviews, book chapters, etc). Please use the PubMed citation format (http://www.ncbi.nlm.nih.gov/staff/beck/citations/citations.html#Samplecitationforajournalarticle:):
Meetings/conferences attended (including CPIN Research Day):
Awards received (while enrolled in CPIN). Please specify: a. Name of each award b. Funding source c. Time period of the award (Year-Year) d. Awarded amount in each case
I have participated in the following CPIN activities:
Volunteer or leadership activities: a. CPIN-related: b. Non-CPIN related (optional):
Immediate Plans Following Graduation:
Career goal:
Please provide any comments and suggestions that you may have to improve CPIN: