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:*

Laboratory activities expected of the student:*

Select*

Were laboratory guidelines/policies (e.g., biohazards, lab notebook) explained to the student? Has the student been provided with a reading list? Is the student expected to attend lab meetings? Will the student be required to present in a lab meeting before the end of the rotation? Does the student have 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 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.*

Yes, (If the rotation works out, I will be able to accept this student into my laboratory in July) Very likely (If the rotation works out, I will very likely be able to accept this student into my laboratory in July) Possibly (If the rotation works out, I will possibly be able to accept this student into my laboratory in July No (I will not be able to accept this student in July) Yes, Student is eligible for NIH Diversity Supplement http://icahn.mssm.edu/diversitysupplements No, Student is not eligible for NIH Diversity Supplement http://icahn.mssm.edu/diversitysupplements

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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