-- Select an option --
This is my first submission
This is a REVISION of my original submission
Select type of submission
Last name
*
First name
*
Your Email
*
-- Select an option --
Select your degree program
MD student
MD GHP student
MD CTRP student
*
-- Select an option --
Select your LC Mentor and House
Blackstone | William (Jerry) Durbin
Blackstone | Michael Ennis
Blackstone | Cynthia Ennis
Blackstone | Sharmilee Korets
Blackstone | Hugh Silk
Blackstone | Rebecca Spanagel
Brightwood | Samuel Borden
Brightwood | Eric Churchill
Brightwood | Elizabeth Eagleson
Brightwood | Jacqueline Wu
Burncoat | Jennifer Bram
Burncoat | Lisa Gussak
Burncoat | David Hatem
Burncoat | Matt McGuiness
Burncoat | Jennifer Moody
Burncoat | Peggy Wu
Kelley | Angela Beeler
Kelley | Gary Blanchard
Kelley | Jay Broadhurst
Kelley | Phil Fournier
Kelley | Sarah McGee
Quinsigamond | Erin Barlow
Quinsigamond | Diane (Dede) Blake
Quinsigamond | Luu Ireland
Quinsigamond | David Kane
Quinsigamond | Glenn Kershaw
Quinsigamond | Zoon Wangu
Tatnuck | Tim Gibson
Tatnuck | Tom Halpin
Tatnuck | Pang-Yen (P.Y.) Fan
Tatnuck | Christine MacGinnis
My LC Mentor isn't listed | see below
Unlisted LC House and Mentor
*
CSD Affiliate
Select your Capstone House Affiliate
Colleen Burnham | Group Project & Kelley MS4
Rachel Gerstein | Blackstone & Tatnuck MS2 MS3 MS4
Tina Hermos | Burncoat
Carolina Ionete | Quinsigamond
Yunsheng Ma | Kelley MS1 MS2 MS3 & Tatnuck MS1
Sarah McAdoo | Brightwood
Advisor Information
Please check the UMass Chan Faculty Profiles webpage to provide accurate and complete information about your Capstone Project Advisor.
Double-check your Project Advisor's email address to ensure s/he receives notification of your submission. of note : umassmemorial .org or umassmed .edu .
Advisor Information
Please check the UMass Chan Faculty Profiles webpage to provide accurate and complete information about your Capstone Project Advisor.
Double-check your Project Advisor's email address to ensure s/he receives notification of your submission. of note : umassmemorial .org or umassmed .edu .
Advisor Name
*
Advisor Email
*
Advisor Department Affiliation
-- Select an option --
Anesthesiology & Perioperative Medicine
Biochemistry & Molecular Pharmacology
Dermatology
Emergency Medicine
Family Medicine & Community Health
Medicine
Microbiology & Physiological Systems
Molecular, Cell & Cancer Biology
Neurobiology
Neurology
Neurosurgery
Obstetrics & Gynecology
Ophthalmology
Orthopedics & Physical Rehabilitation
Otolaryngology
Pathology
Pediatrics
Program in Molecular Medicine
Psychiatry
Quantitative Health Sciences
Radiology
Radiation Oncology
RNA Therapeutics Institute
Surgery
Urology
Select Your Advisor's Department Affiliation
Not UMass Chan | Department recorded below
How did you identify your advisor?
-- Select an option --
Discussion with LC Mentor
Discussion with Faculty
Discussion with another (colleague, friend, etc)
UMass Chan Department Websites
Literature Search
Capstone Resources
Other (explanation below)
Project Information
Project Information
Project Title
*
*
group status
Group Project?
No - this is an individual Capstone Project
Yes - see group member list below
Group Members
Project Inspiration
complete any that apply
Project Inspiration
complete any that apply
Prior Experience Type
Volunteer Organization (or type)
FOM Course Name
UMass Chan Elective Name
Mentor Interaction Type
UMass Chan Interest Group Name
Summer Research Project Title
Other Inspiration
Your Project Proposal
Your Project Proposal
Define Goals
*
Define Objectives
*
Knowledge or Resource Gap
*
Project Outline
*
Project Resources
*
Project Methods and or Processes
*
Additional Potential Challenges not outlined above
Results | Output
*
Product(s) | Deliverable(s)
*
Use of Subjects
Use of Subjects
UMass Chan Institutional Review Board (IRB) Timeline
UMass Chan Institutional Animal Care and Use Committee (IACUC) Timeline
UMass Chan Students as Study Subjects in Educational Research (SAS) Timeline
Please confirm that this is the final version of the FOM2 Fall Advisor Selection and Project Proposal report, and that your Capstone Project Advisor has reviewed your report, provided comments, and determined that it meets expectations .
Please confirm that this is the final version of the FOM2 Fall Advisor Selection and Project Proposal report, and that your Capstone Project Advisor has reviewed your report, provided comments, and determined that it meets expectations .
Advisor Approval Status
*
Advisor approval status
My Capstone Project Advisor has reviewed and approved this report as "meets expectations"
I have set a meeting with my Capstone Project Advisor to review my report
OPTIONAL | Upload supporting documents | eg, proposal worksheet
OPTIONAL | Upload supporting documents | eg, proposal worksheet
Submit Report to Capstone Team