FALL 2020 TRANSMEDTECH EXCELLENCE SCHOLARSHIPS …

FALL 2020 TRANSMEDTECH EXCELLENCE SCHOLARSHIPS GRADUATE STUDENTS AND POSTDOCTORAL FELLOWS

APPLICATION FORM

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SELF-IDENTIFICATION FORM - OPTIONAL INFORMATION

The TransMedTech Institute supports an Equal Opportunity Program and encourages women, members of visible minorities, Aboriginal peoples and persons with disabilities to apply. Self-identifying in one of the four designated groups is voluntary. Choosing not to self-identify will no consequence for you. However, all individuals are encouraged to self-identify where applicable, as the information at an aggregate level is necessary to monitor, evaluate and develop policies to improve (as necessary) the level of equity, diversity and inclusion within our Institute. Please note that access to this information will be limited to the employees of the TransMedTech Institute and that this information will not, at any time, be shared with external reviewers or committee members and will not be used as part of the evaluation of your application.

a. What is the year of your birth ?

I prefer not to answer at this time

b. Do you identify as an Indigenous person, that is, First Nations (North American Indian, Metis or Inuit) ? Note: First Nations include Status and non-Status Indians.

Yes No I prefer not to answer at this time

c. Do you identify as a member of a visible minority ? Note: Visible minority includes persons who are non-Caucasian in race or non-white in colour and who do not report being Aboriginal. This includes Black, Chinese, Filipino, Japanese, Korean, South Asian or East Asian, Southern Asian, non-white West African, North African or Arab, non-white Latin American, person of mixed origin (with one parent in one of the visible minority groups in this list), or other visible minority group.


d. Do you identify as a person with a disability ? Note: A person with a disability is a person who has a long-term or recurring physical, mental, sensory, psychiatric or learning impairment and who:

• Considers themselves to be disadvantaged in employment by reason of that impairment, or • Believes that an employer or potential employer is likely to consider them to be disadvantaged in employment

by reason of that impairment; and • Includes persons whose functional limitations owing to their impairment have been accommodated in their

current job or workplace.



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1. APPLICANT

Last Name First Name

Email

Mailing address

Telephone number

Status in Canada Canadian citizen Permanent resident Student visa Other (specify)

2. CHOICE OF PROFILE

Academic For the student seeking a career as a professor or university researcher

Entrepreneurial For the student who aims to become a medtech entrepreneur

Industrial For the student who aims for a career as a professional within a medtech company

3. STUDY PROGRAM COVERED BY THIS APPLICATION

Level Master-Research PhD Postdoc

University or institution Choisissez un élément. Faculty/School

Department

Name of study program

Start date (yyyy-mm-dd) Expected End Date (yyyy-mm-dd)

4. IDENTIFICATION OF AXIS AND SECTOR OF RESEARCH PROJET Please refer to the Guide – TransMedTech Excellence Scholarships Fall 2020 Competition.

Axes

Diagnostic, prognostic and theranostic technologies ☐ Multimodal and interventional imaging ☐ Laser therapies, biophotonic probes ☐ Microfluidics, precision medicine ☐ Sensors, biomarker measurement

Therapeutic technologies ☐ Nanotechnologies ☐ Simulation, navigation and surgical robotics ☐ Biomaterials, implants, surgical equipment ☐ Minimally-invasive intervention treatments

Rehabilitation technologies ☐ Orthoses, prostheses ☐ Technical aids ☐ Mobility, posture, restoration of functions

Complementary transversal axes

Artificial intelligence Data science Modeling/simulation None

Disease-related sectors Neuro/Musculoskeletal diseases Cardiovascular diseases Cancers


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5. PROJECT TITLE

6. DESCRIPTION OF THE RESEARCH PROJECT (1 000 words max., no image/drawing allowed) Clearly describe your research project according to the following sections: 1- Problem and context, 2- Objectives and hypotheses, 3- Methodology, 4- Expected results, 5- Potential benefit for the medtech industry and/or the health sector. The project description must be written in collaboration with the research directors.


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7. PARTNERS AND COLLABORATORSPlease identify the 3 principal partners and collaborators to the project, excluding the research directors (e.g. researcher,clinician, company, patient, etc.). Briefly describe the expertise and role of each in the project.

A

Last name, First name

Institution

Type of partner List

Expertise (3-5 key words)

Role

B


Institution



Role

C


Institution



Role

8. USERS-PARTNERS INVOLVEMENT IN THE PROJECTThe Transmedtech Institute defines users-partners as stakeholders in the innovation process. These people can be patients, their relatives, caregivers, clinicians, physicians, health professionals, students, the community, health system managers, technical professionals, etc. (Master's, PhD: 250 words max.; Postdoctoral Fellows: 500 words max.): In your project, please identify at least one user-partner. How will this user-partner contribute significantly to your project? How will their participation influence the relevance of the innovation and the solution (ideation, prototyping, validation)? Explain the results expected from the user-partner.


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9. JUSTIFICATION OF TRAINING AND RESEARCH ENVIRONMENT (750 words max.) Identify the location(s) where the research project will be carried out (eg, Lab X of Hospital Y, Company A, Laboratory K of Research Center Z, etc.) and describe the premises, facilities and personnel that will be accessible for the project. You must demonstrate that the environment is conducive to the realization of the project. COVID SITUATION: submit a draft mitigation plan to continue working on the project if work in the premises is not possible.


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10. ADVISORY COMMITTEE COMPOSITION (mentoring team) The advisory committee must be composed of 4 to 5 members of complementary expertise, including the director and research co-director(s), a TransMedTech DIU member (to be assigned by TransMedTech if you obtain the scholarship) and at least one additional member, ideally in the field of health or industry. The research director must be a full-time regular member of an institution member of the TransMedTech Institute (Polytechnique Montréal, University of Montreal, CHU Sainte-Justine, CHUM, Jewish General Hospital). The co-director may come from a non-member institution of the TransMedTech Institute. All research projects must be led by a director and co-director from different and complementary disciplines.

DIRECTOR*


Email

Institution and Department


CO-DIRECTOR*


Email



CO-DIRECTOR


Email



ADDITIONAL MEMBER*


Email



ADDITIONAL MEMBER


Email



*Mandatory


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11. WHY DO YOU WANT TO REALIZE YOUR RESEARCH PROJECT WITHIN THE TRANSMEDTECH INSTITUTE'S LIVING LAB ENVIRONMENT ? (500 words max.) Describe your understanding of the TransMedTech Institute and your interest in being part of this environment. For example, what would be the benefit of realizing your project in a Living Lab mode and within the TransMedTech Institute? (see the Guide – TransMedTech Excellence Scholarships Fall 2020 Competition for more details)


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12. TRAINING EXPERIENCE LIVING LAB (INTERNSHIP) (250 words max.) An internship of a minimum duration of 2 months must be planned during the training. The training environment is unrestricted (biomedical industry, hospital, research center, etc.) and can be divided into several phases, but must be justified according to the career objectives and skills to be developed as part of the TransMedTech training project. In the case of postdoctoral fellows, relevant research experience in an environment complementary to the main environment of the postdoctoral fellowship must be planned. For example, if the postdoctoral project is planned in a university laboratory, a Living Lab training experience could be planned in a hospital setting. In all cases, the internship supervisor must not be the director or co-director of the student or postdoctoral fellow.

Host venue

Internship Supervisor

Training duration

Approximate dates

Description and justification of the internship

13. WHAT IS YOUR CAREER PLAN ? WHAT ARE YOUR MOTIVATIONS ? (750 words max.) Describe precisely your career goals. Identify your current skills and shortcomings and describe the steps and activities to be undertaken to achieve your career goals (eg, training workshops, networking events, internships, etc.). Explain your motivations for continuing your education and pursuing a career in the field of medical technology. Feel free to highlight your successes.


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14. FUNDING PLAN Please consult the Guide – TransMedTech Excellence Scholarships Fall 2020 Competition for details on the funding plan. The annual amount must be equal to or greater than the minimum standard amount, without exceeding the maximum cumulative amount. The contribution of the TransMedTech Institute cannot be higher than half the minimum standard amount. A contribution from the research directors is strongly encouraged, regardless of the funding plan. A $3,000 travel stipend will be offered to all TransMedTech scholars. A $10,000 start-up fund will be available to all postdoctoral fellows for the completion of their project.

(Another page can be added in case of various scenarios possible)

Study Program Maximal duration of the TransMedTech

Scholarship

Minimum Standard Amount ($ CA)

Maximal Cumulative Amount ($ CA)

Maximal Contribution of the

TransMedTech Institute

Research Master 2 years $22 000 / year $30 000 / year $11 000 / year

PhD 3 years $27 000 / year $40 000 / year $13 500 / year

Postdoc 2 years $50 000 / year

+ corresponding benefits, if any

$75 000 / year + corresponding benefits, if any

$25 000 / year + corresponding benefits, if any

Note 1 : Mobility grants and start-up funds should not be included in the financial package presented below. Note 2 : The minimum standard amount must be respected for the entire period of the scholarship. Note 3 : If your funding plan includes a scholarship application that has not yet been submitted or the result of which has not yet been obtained, you must complete an additional line to show the alternative that will be used to reach the minimum standard amount for each year.

Year Partner Amount Amount confirmed?

Start date (dd-mm-yyyy)

End date (dd-mm-yyyy)

1

TransMedTech Institute n/a

Total

2


Total

3 (PhD only)


Total


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15. PREVIOUS UNIVERSITY STUDIES (Provide all records/transcripts)

University Program Degree obtained

Start (mm-yyyy)

End (mm-yyyy)

Obtained Average / Maximal score

Number of Accumulated

credits

16. EXPERIENCE IN RESEARCH AND DEVELOPMENT (eg master's project, internship, professional experience)

Short title of project or position held Institution / Company Start (mm-yyyy)

End (mm-yyyy)

17. AWARDS AND SCHOLARSHIPS (academic only)

Organization Amount (currency)

Start (mm-yyyy)

End (mm-yyyy)

18. PATENTS

Patent Title Location Status Date of filing or publication

List

List

List


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19. PUBLICATIONS For your references, use the format of the complete bibliographic notes of the original publication. Indicate the source of funding if applicable. For publications written by several authors, indicate as a percentage the contribution of each. Add pages as needed by following the categories below.

19.1 Scientific journal articles with peer review committee (indicate the journal's impact factor for each article)

Published Articles

Accepted Articles


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19.2 Scientific journal articles (no peer review panel or no impact factor)

Published Articles

Accepted Articles


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19.3 Scientific Communications

Presented Oral Communications

Accepted Oral Communications Presented Poster Communications

Accepted Poster Communications


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19.4 Book Chapters

Published Chapters

Accepted Chapters

19.5 Reports

Published Reports

Accepted Reports


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20. SIGNATURE The signatories certify the accuracy of the information contained in this application. Through their signature, the director and the co-director(s) confirm that they commit to supervise the student according to the principles of the TransMedTech Living Lab.

Applicant

Last name, First name Signature Date

Research Director


Research Co-director


Research Co-director


Additional Member – Advisory Committee


Additional Member – Advisory Committee


FALL 2020 TRANSMEDTECH EXCELLENCE SCHOLARSHIPS …

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