UMMS Capstone Scholarship and Discovery Project Change Request Form

Your name (last, first)

Your email address

Select your current or anticipated Degree Program

Your Curriculum Year

Current Capstone Advisor name (last, first)

Capstone Team Contact

LC Mentor name

My LC Mentor is

Project title (current working or actual)

If this is a group project, list member names

If this is a group project, have you notified all student members of your group?

Change Type | select the most appropriate category(s) and continue as directed

( note: all submit buttons submit the entire form; you may submit at any point that is appropriate for your change.)

Change of Program - continue with Change of Program section below Change of Topic - continue with Change of Topic section below Change of Design or Methodology - continue with Change of Design/Methods section below Change of Advisor - continue with Change of Advisor section below

Change of Program

I have applied to and been accepted into the Senior Scholars Program I have decided to NOT complete a Senior Scholars project I will be completing a Senior Scholars project IN ADDITION TO my Capstone project

Provide a brief explanation of how this change will impact your Capstone student status (including group membership if applicable)

Change of Topic

Reason for Topic Change (select all that apply)

Difficulty completing original project Desire to work with new advisor Newfound interest Unable to use original design/method Other - explain below

Other reason for change

New Project Title (if applicable)

Provide a short paragraph describing the new topic, including new design or methods.

Describe any IRB, IACUC, and or SAS review implications as a result of your topic change.

Outline the new timeline that you have discussed with your project advisor.

Change of Design or Methodology

Provide a short paragraph explaining the design and or methodological change. Include any IRB, IACUC, and or SAS review implications, and the adjusted timeline you have discussed with your project advisor.

Change of Advisor

Reason for change (select all that apply)

Schedule conflicts Identified advisor with closer interest or expertise Project change (enter change information above) Incompatibility Other - explain below

Other reason for change

Have you discussed this change with your current Capstone Advisor?

New Advisor name (last, first)

Has your new Project Advisor completed the Advisor Interest Form?

Provide a brief explanation of any anticipated impact on other project components (eg, group membership, IRB/IACUC/SAS, etc.)

4.20.2016 cjb