Basic Information

To better understand the diversity of the Connected Minds applicant pool and create a more equitable and inclusive funding program, we are inviting scholarship applicants to provide self-identification data. The survey contains 14 questions and will take approximately 5 minutes to complete.

This form must be completed prior to the application deadline posted on the Connected Minds website.

Even if you are choosing not to self-identify or have chosen not to self-identify in the past we invite you to complete the self-identification form by selecting the "I prefer not to answer" option.

Please note that the self-identification information can only be accessed by the Connected Minds Program Director (Caitlin Mullin), Operations Manager (Tara Tharani), and EDI and Community Outreach Specialist (Andrew Castillo).

For the Masters-level scholarship competition, the adjudication committee will only be made aware if applicants identify as members of underrepresented groups, but no identities will be linked to any names on the application, this is done to protect the identities of individuals. Self-identification information will be password protected and kept on a secure server only accessed by the Connected Minds staff members mentioned above. Information will remain in the server until 2037 as mandated by the Canada First Research Excellence Fund (CFREF).

If you have any questions, please feel free to email Andrew Castillo (, EDI and Community Outreach Specialist for Connected Minds.

Question Title

* 1. Name (First Last)

Question Title

* 2. Please select one of the following option that best describes your situation:

Question Title

* 3. Name of Supervisor (First Last)

Question Title

* 4. Department (if applicable)

Question Title

* 5. If you wish to not self-identify, click here: