1. Healthcare

University of Alberta Doctoral Recruitment
Scholarship Nomination Form
KILLAM CENTRE FOR ADVANCED STUDIES
2-29 TRIFFO HALL
Student ID
Phone: 780.492.3499 Fax: 780.492.0692
http://uofa.ualberta.ca/graduate-studies/
Student Last Name, First Name
Department
Select Department
Scholarship Information
Start Term and Year
Award (2015-2016)
 Spring (May 1st)
 Summer (July 1st)
 Fall (September 1st)
 Winter (January 1st)
Select
JUSTIFICATION (only required if admission GPA is less than A minus = 3.7)
Name of Graduate Coordinator/ Dept Chair
Signature (digital or hand-written)
Date (MM/DD/YYYY)
*This form can be electronically signed, or signed and scanned, and emailed to [email protected] from your UofA email account.
Last modified: 1/28/2015 (1 of 1)