**Application is open for student affiliation to GEFSES for September 2020 - August2021.**

Last Name*:

Middle Name:

First Name*:

Email address*:

Phone Number*:

Date of Birth*:

Address*:


Address Line

City

Province/State

Country

Postal Code/Zip Code

Citizenship Status*:

Specify Country of Citizenship*:

Please provide the names of at least two referees*:

Referee - 1:


Name of Referee

Phone Number

Email

Referee - 2:


Name of Referee

Phone Number

Email

Upload CV*

Graduate Program Information*:

Graduate/Undergraduate Program (registered or applied to):

University Number (if available):

Student Status:

Are you seeking full or partial funding?

University:

Name of University:

Department/School:

Supervisor (if available):

Please provide the name of your supervisor:

Co-Supervisor (if available):

Are you still interested to affiliate yourself with GEFSES to access other resources?

University:

Department/School:

Supervisor (if available):

Co-Supervisor (if available):

Level of Training*:

Program Status:

Please describe your research interests and how they relate to the purpose of the GEFSES-CREATE program. How does your research relate to genome editing? (500 words maximum):

What are your career aspirations? How will enrolment into the CREATE program help you fulfill these aspirations? (250 words maximum):

Please provide concrete examples demonstrating why you are a good candidate for the program. What makes you uniques from other candidates? (relevant skills, experiences, academic achievements etc.,) (250 words maximum):

Why are you interested in GEFSES? What is the motivation behind your pursuing this program? (250 words maximum):

Program Status:

Date of your enrollment to the university:

Thesis/Dissertation Title (or proposed title):

Please describe your thesis/dissertation and how it relates to the purpose of the GEFSES-CREATE program. How does your research relate to genome editing? (500 words maximum):

What are your career aspirations? How will enrollment into the CREATE program help you fulfill these aspirations? (250 words maximum):

Please provide concrete examples demonstrating why you are a good candidate for the program. What makes you uniques from other candidates? (relevant skills, experiences, academic achievements etc.,) (250 words maximum):

Why are you interested in GEFSES? What is the motivation behind your pursuing this program? (250 words maximum):

Affiliation with GEFSES will require you to complete an externship (8-12 weeks) preferably in a related but different field than your major area of research. Please answer the following questions related to the externship:

Which type of externship are you interested in? (choose any of the following: industry, policy, risk assessment & regulation, government research laboratory, laboratory exchange)

The externship period will be eight to twelve weeks, please list below all the months you are available to complete your externship. (Please provide the months with year, up to maximum one year after your affiliation has concluded)

What would you like to gain from your externship experience?

What unique skillsets do you bring to this externship? What are specific skills you would like to learn?

Do you currently have an externship secured? If yes, please describe this opportunity below. (Which institution, location, duration, etc.)

Upload List of Publications (if applicable)

Program Status:

Date of your enrolment to the university:

Thesis/Dissertation Title (or proposed title):

Please describe your thesis/dissertation and how it relates to the purpose of the GEFSES-CREATE program. How does your research relate to genome editing? (500 words maximum):

What are your career aspirations? How will enrolment into the CREATE program help you fulfill these aspirations? (250 words maximum):

Please provide concrete examples demonstrating why you are a good candidate for the program. What makes you uniques from other candidates? (relevant skills, experiences, academic achievements etc.,) (250 words maximum):

Why are you interested in GEFSES? What is the motivation behind your pursuing this program? (250 words maximum):

Affiliation with GEFSES will require you to complete an externship (8-12 weeks) preferably in a related but different field than your major area of research. Please answer the following questions related to the externship:

Which type of externship are you interested in? (choose any of the following: industry, policy, risk assessment & regulation, government research laboratory, laboratory exchange)

The externship period will be eight to twelve weeks, please list below all the months you are available to complete your externship. (Please provide the months with year, up to maximum one year after your affiliation has concluded)

What would you like to gain from your externship experience?

What unique skillsets do you bring to this externship? What are specific skills you would like to learn?

Do you currently have an externship secured? If yes, please describe this opportunity below. (Which institution, location, duration, etc.)

Upload List of Publications (if applicable)

Do you have a PI's referrral?

Do you have secured funding?

What are your career aspirations? How will enrolment into the CREATE program help you fulfill these aspirations? (250 words maximum):

Briefly describe your research interests and their relation to genome editing. (250 words maximum):

Briefly explain your teaching philosophy (250 words maximum):

If affiliated with GEFSES how do you see yourself working collaboratively with graduate students regarding their research, teaching and training? (250 words maximum):

Please provide concrete examples demonstrating why you are a good candidate for the program. What makes you uniques from other candidates? (relevant skills, experiences, academic achievements etc.,) (250 words maximum):

Why are you interested in GEFSES? What is the motivation behind your pursuing this program? (250 words maximum):

Upload List of Publications (if applicable)

The positions are not currently available. Contact GEFSES Coordinator for future openings.

Verifying Submission*:

I hereby certify I am aware that once selected for affiliation with GEFSES, I will be responsible to complete two online courses and an annual workshop during the year of affiliation; along with completing an externship (8-12 weeks) preferably in a related but different field than your major area of research. If you agree, please provide your electronic signature by writing your full legal name:

By clicking *Submit* - I certify that all information contained in the application and all information I will provide later (electronically or otherwise) related to this application, including any amendments, are and will be accurate and complete.

I authorize GEFSES-CREATE to exchange all information regarding my application for reporting purposes.

I certify that I have attached (electronically) the following documents:
• CV
• List of publications and presentations (if applicable)

**Please note that GEFSES affiliated trainees are required to complete various training components, including two courses, participation in the annual workshop and externships.

I am ready to submit my application: