GS Lab Rotation Agreement - Formstack

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Fields

Laboratory Rotation Agreement - Student

Student Name*

First Name*

Last Name*

Student Email Address*

Life Number*

Degree*

PhD Student MD / PhD Student

MTA

Lab Rotation #

Rotation Preceptor Name*

First Name*

Last Name*

Rotation Preceptor Email*

Rotation Start Date

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Month

Day

Year

Rotation End Date*

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Month

Day

Year

Laboratory Rotation Agreement - Rotation Preceptor

Who will directly supervise the student?

First Name

Last Name

Hours per week that a student is expected to be in the laboratory:*

maximum: 20 hours/week while taking core courses

Laboratory activities expected of the student:*

Select all that apply*

Laboratory guidelines/policies (e.g., biohazards, lab notebook) were explained to the student. Student been provided with a reading list. Student expected to attend lab meetings. Student be required to present in a lab meeting before the end of the rotation. The student is expected to participate in departmental seminars.

Goals for this rotation:*

Has the student met with his/her first year advisor?*

Yes No

Other: Other Value

At the end of this rotation the student will meet with the rotation preceptor and complete the Laboratory Rotation Evaluation Form.

If, at the end of the rotation period, you and the student wish to have the student join your lab, will you have sufficient space and financial support to host the student?*

Yes. I anticipate being able to accept this student into my laboratory Maybe. I might be able to accept this student into my laboratory No, I would not be able to accept this student

Choose one:

PI Funding Student is eligible for a diversity supplement.

Please describe the funding source you will use (provide name/type of grant or fund number if known):

Choose a financial approver from this list to receive a copy of this rotation agreement via email.

(If your approver is not listed, email gs-admin@mssm.edu to have them added.)

BY SIGNATURE, I VERIFY THAT I HAVE DISCUSSED THE LIKELIHOOD OF MY HAVING SPACE AND FINANCIAL SUPPORT, SHOULD THIS STUDENT AND I WISH TO CONSIDER A THESIS DEVELOPMENT AFTER THE ROTATION PERIOD.

Rotation Preceptor Signature*

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Student Approval

Approve*

Yes

Signature

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Graduate School Office Approval

Approve*

Yes

Signature

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