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^{Academic Supervisor Application Form}

^{Academic Supervisor's Information and Statement of Proposed Research}

Family Name

Given Name

Initial(s)

Attach up to 2 pages on Academic Supervisor's recent and relevant research

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Assistant/associate/full/adjunct professor

Tenure-stream Appointment?

University affiliation

Department

Telephone

Email address

^{Student/Academic Supervisor Relationship}

Is the Academic Supervisor also supervising the student applicant's thesis?

What other funding support will this student have / apply for to support his / her graduate program?

Is this students' acceptance to graduate school subject to having funding in place?

^{Research Timeline}

Proposed Starting Date

Proposed Completion Date

^{Proposed Research Project}

Title of proposed research project

Summary of proposed research project - Indicate the objectives, scientific approach, novelty, and expected significance of the work to the mandate of TSSA. Please attache a 1 page bibliography and 1-2 page summary.

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List other funding support that you have / will apply for to support your research program

^Signatures

I herby certify that the above student will participate in and complete the research program outlined in this application and within the timeline defined in this application.

Academic Supervisor's Signature

Clear

Dean/Head of Department's signature

Clear

^{PART 3 - To be Completed by the Academic Supervisor}

The nature of TSSA Safety Education Fund Graduate Scholarship application is inherently a collaboration between supervisor and student applicant. As the proposed academic supervisor, this allows you to appraise the student's writing, organization, and research skills. In the format of your choice, please appraise this student applicant in relation to (1) the relevance of his or her background preparation (prior studies), (2) initiative, and (3) likelihood of completing the program and making a valuable contribution to public safety and (4) any other qualities or attributes you consider important to success in graduate studies. Please comment on the student applicant in relation to other students at a similar level of education in your past experience.

Please comment on the student applicant in relation to other students at a similar level of education in your past experience.

What proportion of the 2-page proposal itself was crafted by each of the Academic Supervisor and the Graduate Student? (e.g., 50:50, 30:70, 60:40 etc.)?

How is this proposed student project relevant to your research program as faculty supervisor? Please describe your recent and ongoing and intended research in relation to this proposed project.

AGREEMENT REGARDING SUPERVISION ROLE OF ACADEMIC SUPERVISOR

I herby certify that the above student will participate in and complete the research program outlined in this application and within the timeline defined in this application.

Clear