2016-2017 Research, Academic Medicine, and Scholarly Project Form
In order to complete a Research, Academic Medicine, or Scholarly Project Block, you must have an advisor and a specific project.
Your project must be approved by your advisor before completing this form.
For Research and Academic Medicine Blocks, this must be submitted no later than 4 weeks prior to the start date of the rotation.
For Scholarly Projects, this must be submitted by Oct 1st 2016.
At the completion of the Block or on March 26th for Scholarly Projects, your faculty advisor will be sent your evaluation form.
Student First Name
Student Last Name
4 week - Block 1: 5/10/2016 to 6/5/2016
4 week - Block 2: 6/6/2016 to 7/3/2016
4 week - Block 3: 7/5/2016 to 7/31/2016
4 week - Block 4: 8/1/2016 to 8/28/2016
4 week - Block 5: 8/29/2016 to 9/25/2016
4 week - Block 6: 9/26/2016 to 10/23/2016
4 week - Block 7: 10/24/2016 to 11/20/2016 (Scholarly Project option)
4 week - Block 8: 11/21/2016 to 12/18/2016 (Scholarly Project option)
4 week - Block 9: 1/3/2017 to 1/29/2017 (Scholarly Project option)
4 week - Block 10: 1/30/2017 to 2/26/2017
4 week - Block 11: 2/27/2017 to 3/26/2017
4 week - Block 12: 3/27/2017 to 4/23/2017
Type of Project
Description of the Approved Research/Academic Medicine/Scholarly Project Plan:
Advisor First and Last Name
Advisor Email address
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