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CSIN Student Completion Form
CSIN graduate students who have completed both their home department and CSIN trainee requirements must fill in the below completion form.
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Graduating Student Information
Student Name:
Student Number:
E-mail Address:
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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:
Enter a valid email address. Example: name@company.com
Home Department:
Applied Psychology and Human Development
Biochemistry
Biomedical Engineering
Cell and Systems Biology
Computer Science
Dentistry
Laboratory Medicine and Pathobiology
Medical Biophysics
Institute of Medical Science
Music
Pharmaceutical Sciences
Pharmacology and Toxicology
Physiology
Psychology
Rehabilitation Science
Other
Program:
PhD
MSc
MA
MASc
MHSc
MPH
Program Start Date:
Program End Date:
Supervisor's Name:
Supervisor's Email Address:
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Thesis Title:
Please attach a copy of your Thesis Title page:
Completion of CSIN Program Requirements
Approved neuroscience course(s) completed:
Please attach a screen shot from ROSI showing that you have completed the CSIN 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:
Please attach a PDF version of your CV:
Session Expiry
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