CSAM-SMCA Student Bursary

Note: All fields are required
Bursaries
Which bursary are you applying for?*
- CSAM-SMCA Student Full Conference Travel Bursary
- CSAM-SMCA Student Full Conference Bursary
- CSAM-SMCA Student Fundamentals of Addiction Conference Bursary
Personal Information
Name*
First Last
Email*
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
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*
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.
Drop files here or

Accepted file types: pdf, doc, docx, txt, , Max. file size: 5 MB, Max. files: 2.
Consent
Confirmation*
I have read the terms and conditions of the CSAM-SMCA Scientific Conference Bursaries and hereby certify that the information provided in this application is correct. I understand that any false statements made in any part of this application may be sufficient cause for rejection of my application or withdrawal of a bursary award.*
Date*
Month
Day
Year

CSAM-SMCA Student Bursary

Bursaries

Personal Information

Education

Questions

Reference Letters

Consent

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