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2015 HEATER Thermoelectrics School and Workshop

Trainee Registration Form

Surname

Given Name

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e-mail: Citizenship Status as of September 1, 2015:

Canadian Citizen Permanent Resident International Student

University:

Degree Program: (e.g. Chemistry, BSc.)

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Start Date of Current Degree:

Expected Date of Completion:

PRIVACY NOTICE – NSERC requires the CREATE HEATER Program to collect certain personal information from trainees participating in the CREATE program. The purpose of gathering this information is to generate statistics that enable NSERC to report on the CREATE program’s overall performance. Only information that is needed will be requested of the trainees. The personal information that is

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collected, used and disclosed is in accordance with the federal Privacy Act. The personal information may also be shared with contractors hired to conduct data analysis, surveys, or interviews on NSERC’s behalf.

Trainee’s Signature

Date

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Return completed form by October 30, 2015 to Erin Bell at:

[email protected]