Your name (last, first)
*
Your Email
*
*
-- Select an option --
Foundations of Medicine 2 (FOM2)
Core Clinical Experiences (CCE)
Advanced Studies (AS)
LOA [explain below]
Select your curriculum year
Briefly explain your LOA status (eg, exit/return date)
Current Capstone Advisor Name (last, first)
Your Capstone Affiliate
-- Select an option --
Group | Colleen Burnham
Blackstone | Rachel Gerstein
Brightwood | Sarah McAdoo
Burncoat | Tina Hermos
Kelley | Rachel Gerstein & Mayra Tisminetzky
Quinsigamond | Colleen Burnham & Xiaoduo Fan
Tatnuck | Jill Zitzewitz
Select your Capstone Affiliate
Current Project Title
If this is a group project, list member names
Change Type select the most appropriate category(s) and continue as directed
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 Desing/Methodology section below
Change of Advisor - continue with Change of Advisor section below
This is large font to force a space between sections 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)
This is large font in white to force a space between sections Change of Topic Include in your explanation your rationale for making the change, eg, difficulty completing original project, desire to work with new advisor, newfound interest, etc.
Rationale 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.
This is large font in white to force a space between sections 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.
This is large font in white to force a space between sections Change of Advisor
Briefly describe the reason for this change, such as schedule conflicts, incompatibility, interests changed, etc. Include any anticipated impact on other project components such as group membership, IRB, etc.
New Advisor Name (last, first)
New Advisor Email
I have discussed this change with my current Capstone Project Advisor
My new Project Advisor has completed the Advisor Interest form
Submit to Capstone Course Team
