1. Applicant Information

1. CIHR Personal Identification Number (PIN)
   Enter your CIHR PIN. If you do not have one, visit the new user registration page to register for a PIN and password.
2. Name of Applicant
   Provide your family name and given name.
3. Affiliation
   Indicate the name of the university or institution where you are a student or post-doctoral fellow and your program of enrollment (B.Sc., M.Sc., PhD, etc)
4. Institution paid
   Applicable if already a CIHR grantee
5. Address
   Please provide both your personal and institutional address
6. Telephone number
   Please provide your personal telephone number(s)
7. Email
   

2. Request for Funding Information

1. Project title
   Please provide the full reference for your published article (Title, Authors, name of journal, volume, page numbers, year). Please attach an electronic copy of your article to the completed form.
   Are you applying as an.?
   Select as an "individual."
2. If you are requesting funds from other CIHR Institutes please indicate them
   Not applicable.
3. If you are requesting funds from other sources then CIHR please indicate them
   Indicate if you have already requested or plan to request funds from sources other than CIHR; if yes, please specify the sources and amounts requested from other sources.
4. Total amount requested
   Maximum amount that can be requested is $1,000.
5. Start date of funding request: month/day/year
   Not applicable.
6. Duration of funding request (in months)
   Not applicable.
7. Using the following model, please submit, as an attachment to this application, a budget table that includes names of all funding sources, amounts and timelines requested for his activity
   Not applicable.
8. Provide a justification for the amount and duration of the funding request
   Not applicable.

3. Activity Description

1. Provide the rationale and objective(s) of the funding request
   In this section; please provide a brief biographical sketch including information about previous training, research experience and current training.
2. How does this request align with the Institute's mandate?
   Discuss how your research paper is aligned with the INMHA mandate/vision.
3. Provide a description of the activities for which support is being requested
   Please discuss the relevance and significance of your paper in the broader context of the field of neuroscience, mental health and addiction, it's impact beyond the specific field of study and on the target audience (including a discussion as to why the journal of publication was chosen).
4. Provide the anticipated outcomes of the funding request
   Not required - covered in c) above.
5. Provide information on the anticipate size of the target audience and the specific intended use of the CIHR grant or award
   Not required - covered in c) above.
6. Describe the need for this activity, including a statement why this request cannot be funded under existing CIHR funding programs
   Not applicable.

4. Signature

A signature is mandatory.

Please e-mail the ICS form and the electronic copy of your article to Nathalie Gendron.

Send the completed application package by courier/ registered mail to:

Nathalie Gendron  
Assistant Director
Institute of Neurosciences, Mental Health and Addiction
Canadian Institutes of Health Research
160 Elgin Street, 9^th Floor
Address Locator 4809A
Ottawa, Ontario K1A 0W9
Email: nathalie.gendron@cihr-irsc.gc.ca