International Visiting Research Trainee (IVRT) Application Form

International Visiting Research Trainee (IVRT) Application Form

Personal information in connection with this form is collected under the authority of Freedom of Information and Protection of Privacy Act (FIPPA) and The York University Act, 1965. If you have any questions about the collection of this information by York University, please contact the Information, Privacy and Copyright Office, 1050 Kaneff Tower, York University, 4700 Keele St. Toronto ON Canada M3J 1P3 Phone: (416) 736-2100 Email: info.privacy@yorku.ca

Personal Information
Name Name * First Last
Gender *

Gender Male Female Prefer not to respond Not listed, please specify: Not listed, please specify:

Your gender information will be used to help you with immigration documents to match our system as your passport and enrollment of health insurance.
Date of Birth Date of Birth * / MM / DD YYYY
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Country of Citizenship *
Passport Bio Page *

Attach Files
Email *
Phone *
Academic Information
Name of home institution *
Web Site of home institution *
Address of home institution Address of home institution *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Degree saught at home institution *
Program of study (specialization, major, minor) *
Visit Information
Name of host faculty member/supervisor at York University Name of host faculty member/supervisor at York University * First Last
Email of faculty member/supervisor *
Faculty at York University *
Program at York University (Department/Centre)
Topic/title of your research project at York University *
Participation start date Participation start date * / DD / MM YYYY
Participation end date Participation end date * / DD / MM YYYY
Source of Funding *

Source of Funding Mitacs Canada tri-council CIHR Global Affairs Canada Canada tri-council NSERC Home Institution Canada tri-council SSHRC York University ERASMUS Self-funded China Scholarship Council Other Other
Health Insurance

*University Health Insurance Plan (UHIP) is mandatory for all IVRTs. To be exempted from UHIP, Sun Life must approve an exemption. For information regarding whether you qualify for a UHIP exemption, please visit, https://yorkinternational.yorku.ca/uhip/
If a third party is to cover UHIP fees, please provide budget number (fund#, cost centre#, account code#)
Supporting Documents
Letter of Invitation by Associate Dean, Research

Visit the website to download the template - https://yorkinternational.yorku.ca/international-visiting-research-trainee/

Contact your faculty supervisor for ADR's approval. Upload it once fully signed by ADR. *

Attach Files
Proof of full-time enrolment in good standing at home university. *

Attach Files
Proof of English Proficiency from home university or a thirt-party test results (e.g. IELP, TOEFL) *

Attach Files
Resume/CV

Attach Files
Declaration and Consent of IVRT Applicant
*

I declare that the information I have provided in this form is true, complete and accurate in all respects and that all available information requested in this form has been disclosed. I declare that I agree with all payment requirements associated with my visit as an IVRT at York, and that I will be responsible for the fees unless stipulated otherwise. All information I have provided in connection with this form is subject to verification and audit by York University. I consent to the disclosure by York University of personal information I have given in this form for the purpose of facilitating the visit While at York, I agree to abide by the University’s policies and procedures, which are available on the University web site at http://www.yorku.ca/secretariat/policies/index-policies.html. I understand that any misrepresentations on this form or failure to provide my consent to authorize York University to verify my information on this form may result in the delay or refusal of the application. Upon arrival, I will contact the UHIP administrator at uhip@yorku.ca to enroll in health insurance plan which is mandatory for all IVRTs (at a cost of $63 per month single coverage).
Draw your signature into the box below. *

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