Research Elective Request Form

Research Elective Request Form

Students may obtain elective credit for both AOSC and non-AOSC research. Total elective credit for research (AOSC-related and non-AOSC) must not exceed 12 weeks. Students may request up to one month of research in two-week blocks (i.e., a total of two, non-contiguous two-week blocks are allowed). All other research electives must be taken in at least one-month blocks. Flex time can always be used to conduct research (including one week at a time).

All requests for research electives must be approved by the student’s research mentor and submitted to FSM Student Research for final approval before an elective can be scheduled.

A separate form must be filled out for each non-contiguous research block.

The completed form should be submitted for approval at least two weeks prior to starting the research block. You may not request elective credit for research time retroactively.

Once your elective request is approved, the registrar will be informed and the research elective will be added to your schedule in OASIS in the block you requested.

Student Name Student Name First Last
Student NetID
Student Email
Date of application Date of application / MM / DD YYYY
Project Title
What do you intend to accomplish in the allotted time and what will be the specific outcome?
Project Description (include your specific role on the project):
Project Mentor Name
Project Mentor Email
Start date Start date / MM / DD YYYY
End date End date / MM / DD YYYY
Number of elective credit weeks requested (Min is 2 weeks; max is 12 weeks)
Are you performing this research with an NU affiliated faculty (including Lurie Children's Hospital, Shirley Ryan Ability Lab, NU, Kellogg, etc.)

Are you performing this research with an NU affiliated faculty (including Lurie Children's Hospital, Shirley Ryan Ability Lab, NU, Kellogg, etc.) Yes No Other Other
Are you performing this research as part of a fellowship?

Are you performing this research as part of a fellowship? Yes No Other Other
Name of Fellowship

Name of Fellowship NIH Medical Research Fellowship Fullbright Forgarty Doris Duke Schweitzer Fellowship RISE Other Other
Is this a funded research position?

Is this a funded research position? Yes No
Please upload a copy of a letter indicating you have received this fellowship

Attach Files
Additional documents (optional)

Attach Files
By putting my name below, I attest that I have reviewed the contents of this form with my mentor and that my mentor agrees that I schedule the elective time requested above in order to complete the proposed outcome. In our mutual estimation, it is a reasonable amount of time in which to complete the stated work. By putting my name below, I attest that I have reviewed the contents of this form with my mentor and that my mentor agrees that I schedule the elective time requested above in order to complete the proposed outcome. In our mutual estimation, it is a reasonable amount of time in which to complete the stated work. First Last
For how many weeks are you requesting elective credit? (Min is 2; Max is 12)
Start/Stop dates
Blocks
Name of facutly mentor
Email of AOSC mentor (if this is an AOSC project)
Is this AOSC related research?

Is this AOSC related research? Yes No Other Other