APPLICATION : Distance Learning Workshop

First register on the Website, http://www.mother-child.org, if you have not already done so.

Family and Given Names
Family Name
Given Names
Experience
Most recent degree
Years since most recent degree
Years of research experience
Plans
Setting for your planned research
d)Do you plan to use this workshop experience to prepare a specific application for submission to one or more funding agencies during the next 12 months?
If answer above is yes, please state the subject of your proposal.
If answer above is yes, please state the granting agency.
Workshop Information
Would you prefer to receive your course materials and mentoring in English or French?
It will be extremely important that you complete your evaluation of the workshop after it has been completed. Please indicate your agreement to complete such a form to be provided to you at a later date.