T-CAIREM • 2022 Student Trainee Rounds application

This form is intended for students interested in applying for the 2022 Student Trainee Rounds for AI in Medicine.

Selected students will be awarded the opportunity to present their research to AI in healthcare leaders in monthly seminars that will begin in February 2022.

The program is administered by T-CAIREM at the University of Toronto's Temerty Faculty of Medicine.

DEADLINE: 5pm on January 14. Late applications will not be considered.
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PLEASE NOTE:
• No other attachments such as reference letters or resumes will be considered along with this application.

For questions about the Student Trainee Rounds or this application process, contact:
Zoryana Salo
T-CAIREM Centre Administrator
zoryana.salo@utoronto.ca

STUDENT INFORMATION
Name Name First Middle Last
Name of student, including middle name if applicable.
Phone number Phone number - ### - ### ####
Institutional email address
Other email address

Student's preferred email address (if different from above)
UofT ROSI ID number (If applicable)
Maximum of 10 characters allowed. Currently Entered: 0 characters.
Degree/training program

Student's degree/training program. (Specify if you’re a graduate student or a medical student.)
Years to date in degree/training program

How many years have you spent to date in your degree/training program?
Primary department at U of T
SUPERVISOR AND RESEARCH PROJECT INFORMATION
Supervisor's name Supervisor's name First Last
(Name of supervisor, if applicable)
Supervisor's email
Supervisor’s primary U of T department
Abstract title
Maximum of 20 words allowed. Currently Entered: 0 words.
Abstract
Maximum of 300 words allowed. Currently Entered: 0 words.
Upload a table/figure (if required)
Maximum: 1 table & 1 figure in PDF format

Attach Files
Keywords to describe the research field (up to 5):
Maximum of 20 words allowed. Currently Entered: 0 words.
DIVERSITY SURVEY (optional)

The University of Toronto is strongly committed to equity and diversity within its community and welcomes applications from racialized persons/persons of colour, women, Indigenous / Aboriginal people, persons with disabilities, LGBTQ persons, and others who may contribute to the further diversification of ideas. To further this commitment and help to evaluate the effectiveness of our recruitment processes, the University requests that you complete the following questionnaire. Your response is voluntary and the information that you provide is strictly confidential.

None of your individual responses will be made available to the department or faculty to which you are applying. The Human Resources office, generalist, or interviewing committee will not be provided with any information you disclose in the questionnaire. Summaries of the responses to this diversity questionnaire will be used for identifying recruitment trends and development of programming to support recruitment.Thank you for assisting the University in achieving its diversity goals.

For the diversity questions below, please select all that apply and at least one.
______________________
Gender and Gender Identity
Which of the following gender do you self-identify as?

Gender and Gender Identity
Which of the following gender do you self-identify as? Man Woman Transgender* Two-Spirit Another gender identity I choose not to answer

*Definition: Transgender refers to a person who self-identifies with a gender other than the one assigned to them at birth, or to a person whose gender identity and gender expression differs from stereotypical masculine and feminine norms. It is also used as an umbrella term for those who identify as transgender, transsexual, trans, gender variant, gender non-conforming, genderqueer, or an analogous term.
Sexual Orientation
Which of the following sexual orientations do you self-identify with?

Sexual Orientation
Which of the following sexual orientations do you self-identify with? Gay Lesbian Straight/Heterosexual Bisexual Queer Two-Spirit Another identity or term I choose not to answer
Persons with Disabilities
Do you self-identify as a person with a disability?

Persons with Disabilities
Do you self-identify as a person with a disability? Yes - Visible Yes - Non-Visible* Yes - Both No I choose not to answer

Definition: Persons with disabilities are persons who have a long-term or recurring physical, mental, sensory, psychiatric or learning impairment(s) AND

A) who consider themselves to be disadvantaged in employment by reason of that impairment, OR
B) believe that an employer or potential employer is likely to consider them to be disadvantaged in employment by reason of that impairment.
C)This also includes persons with disabilities who have been accommodated in their current job or workplace. For a list of examples of disabilities, see uoft.me/UR.

*"Invisible disability" or non-visible is a term commonly used to describe a disability which is non-evident or not readily apparent to others.
Indigenous / Aboriginal People of North America
Do you self-identify as an Indigenous / Aboriginal person of North America?

Indigenous / Aboriginal People of North America
Do you self-identify as an Indigenous / Aboriginal person of North America? Yes - First Nations Yes - Métis Yes - Inuit Yes - Native American - North American Indian (US) Yes - Multiple or Other No I choose not to answer

Definition: Indigenous / Aboriginal People of North America are those who self-identify as First Nations (status, non-status, treaty or non-treaty), Métis, Inuit, or Native American (US).
Racialized Persons / Persons of Colour
Do you self-identify as a “Person of Colour”, or “Racialized Person”?

Racialized Persons / Persons of Colour
Do you self-identify as a “Person of Colour”, or “Racialized Person”? Yes No I choose not to answer

Definition:Individuals who self-identify as racialized persons / persons of colour are persons, other than Indigenous / Aboriginal People of North America (defined below), who are non-Caucasian in race or non-white in colour, regardless of place of birth or citizenship.
Race and Ethnicity
Which of the following do you self-identify as?

Race and Ethnicity
Which of the following do you self-identify as? Asian Black Latin / Hispanic Middle Eastern White Mixed race I choose not to answer

This self-identification is not intended as an indication of one’s place of origin, citizenship, language or culture and recognizes that there are differences both between and among subgroups.
The options below originated from the categories used for collection of data and statistical purposes by the Federal Contractors Program.

T-CAIREM • 2022 Student Trainee Rounds application

T-CAIREM • 2022 Student Trainee Rounds application

STUDENT INFORMATION

SUPERVISOR AND RESEARCH PROJECT INFORMATION