Date: Monday, May 20, 2024

PART A - Applicant Information

1.	* First Name [ First Name ] is required[ First Name ] can only contain letters * Last Name [ Last Name ] is required[ Last Name ] can only contain letters * Home Phone [ Home Phone ] is required Cell Phone * Personal email Please enter a valid [ E-mail ] [ Personal Email ] is required

2.	Address (where you want correspondence sent)
	* Street Address   [ Street Address ] is required * City/Town   [ City/Town ] is required * Postal Code   [ Postal Code ] is required Is this your permanent address?   Yes No

3.

Membership Information

* OSSTF/FEESO Membership Number [ Membership No. ] is required * OSSTF/FEESO District No & Name - Select - 01 Ontario North East District 02 Algoma District 03 Rainbow District 04 Near North District 05A Northern Shield District 05B Rainy River District 06A Thunder Bay District 06B Superior-North District 07 Bluewater District 08 Avon Maitland District 09 Greater Essex District 10 Lambton Kent District 11 Thames Valley District 12 Toronto District 13 Durham District 14 Kawartha Pine Ridge District 15 Trillium Lakelands District 16 York Region District 17 Simcoe District 18 Upper Grand District 19 Peel District 20 Halton District 21 Hamilton-Wentworth District 22 Niagara District 23 Grand Erie District 24 Waterloo District 25 Ottawa-Carleton District 26 Upper-Canada District 27 Limestone District 28 Renfrew District 29 Hastings-Prince Edward District 30 PSAT District 31 Franco-Nord Ontarien District 32 Centre-Sud-Ouest de l'Ontario District 33 District de l'Est 34 Private Schools District 35 Universities and Colleges District [ District Name ] is required * OSSTF/FEESO Bargaining Unit Name - Select - Teacher Occasional Teacher PSSP Educational Support Staff University Other [ Bargaining Unit Name ] is required     If other, please specify:

4.	*	Name of Employer	[ Name of Employer ] is required
	*	Name of Work Location/School	[ Name of School/Workplace ] is required

5.	*	Professional Position at Present
		[ Professional Position at Present ] is required

6.	a)	*	Indicate whether you have previously received any of the five OSSTF/FEESO scholarships or awards listed below:
			Yes No [ Indicate whether... ] is required
			J.W. Ansley Grant for Educational Research S. Hunter Henry Grant I.M. (Brick) Robb Fellowship Dr. S.G.B. Robinson Travelling Grant OSSTF/FEESO Educational Enhancement Grant   What was the value of the award? $ Failure to submit the required written report(s) for any of the above will disqualify your application from being considered for any OSSTF/FEESO scholarships or awards in the future.
	b)	*	Have you received / are you receiving any scholarships and/or bursaries for the period covered by this application?
			Yes No [ Have you received ... ] is required
			If yes, what is the total value of the funding? $

7.	Indicate which of the following will apply while you are involved in your study:
	Dates       No Leave           Leave of Absence without pay:   From to Leave of Absence with pay:             Sabbatical   From to Self-funded Leave (x over y plan)   From to Other:   From to If ''other'', please specify:

8.	Specify anticipated expenses for your research project:
	*   $ [ Anticipated Expenses ] is required [ Dollar amount ] is required     $     $     $     $   TOTAL EXPENSES * $ [ Total Expenses ] is required

9.	Academic and Professional Qualifications
	i.	Date Received	Degrees (including subject area and content specialization, etc.)
	ii.	Date Received	Diplomas (including subject area and content specialization, etc.)
	iii.	Date Received	Certificates (including content specialization, etc.)

PART B - Research Information

1.	*	Title of your research project:
		[ title of research ... ] is required

2.	*	Location(s) where research project will take place:
		[ Location(s) where research ... ] is required

3.	*	Length of research program (give inclusive dates - years and months)
		From   to
		[ Length of research (From) ] is required [ Length of research (to) ] is required

4.	*	Are you currently involved in the above research?
		No Yes [ Are you currently ... ] is required

5.	*	Synopsis
		provide a brief synopsis, 150 words maximum, of your proposed plan of study. If you are successful in your application, this synopsis may be used as the basis for any publications describing your award.
		[ Provide a brief ...] is required

6.	*	Research Goal (max. 500 words)
		Outline the goal of the research, research methods to be employed, sources of information, and any previous work completed by you in the area of research.
		[ Outline the Goal... ] is required

7.	a)	Does this research involve human or animal subjects?	No Yes
	b)	If this research involves human or animal subjects, please provide a copy of approval by your employer's/institution's ethics committee.
		Approval attached (Filetypes allowed: .wpd / .pdf / .doc / .docx / .txt)
		To be sent directly to OSST/FEESO provincial office

8.	*	Describe the relevance of your research to your present job and to education in Ontario.
	[ Describe the relevance... ] is required

9.	Letters of Recommendation (each letter of recommendation should outline your suitability for this award.) OSSTF/FEESO is unable to advise you what should be contained in your letters of recommendation.
	Indicate the names and positions of persons submitting letters of recommendation on your behalf:
	a) OSSTF Member
	* Name [ Name ] is required * Position [ Position ] is required   Letter attached (File types allowed: .wpd / .pdf / .doc / .docx / .txt)     To be sent directly to OSST/FEESO provincial office
	b) Additional Colleague
	* Name [ Name ] is required * Position [ Position ] is required   Letter attached (File types allowed: .wpd / .pdf / .doc / .docx / .txt)     To be sent directly to OSST/FEESO provincial office

It is the applicant’s responsibility to ensure all documentation is received by the provincial office no later than April 1 in order for your application to be considered complete.

I hereby consent to the collection and use of the above-noted information by the Ontario Secondary School Teachers' Federation. This information shall be used exclusively for the purposes of union administration and the representation of our members.

*

Name of applicant:

[ Name of applicant ] is required