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.

Click here to view the CSIN Student requirements.

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:

I identify my gender as:

I identify as:

Home Department:*

Program:

Program Start Date:*

Program End Date:*

Supervisor's Name:*

Supervisor's E-mail Address:*

Thesis Title:*

Date of Thesis Defense (CPIN Completion form should be filled out after defending):*

Completion of CSIN Program Requirements

Approved neuroscience course(s) completed:*

Date(s) of CPIN Research Day Presentation(s) in YYYY-MM-DD format:*

Distinguished Lectures and other lectures attended (name of speaker or date of lecture sufficient):*

Please attach a screen shot from ACORN showing that you have completed the CSIN course requirements:*

One file only.
10 MB limit.
Allowed types: jpg, jpeg, png, pdf.

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:*

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:*

One file only.
10 MB limit.
Allowed types: pdf.