Contract Form – Senior Research/Internship Course
BIOL/ENSC/MATH/MSCI 4902/4903
These courses will oversee an independent study research project or internship
experience by students relevant to their area of study. The student must submit this formal
request (Contract Form) signed by the student’s research project mentor/supervisor and
their academic advisor. It is preferable that the student have a research project or internship
planned and this form signed prior to enrollment in these courses. The form must be signed
and submitted to the course instructor of record in order to continue to be enrolled in these
courses. If it is not, then the student will be administratively withdrawn from the course by
the instructor. The 4902 course can be taken for 1, 2, or 3 credits, and can be repeated (as
4903) once.
Name
Address
_______________________
_______________________
_______________________
_______________________
Major
Academic Advisor
Student ID
Phone
e-mail
____________
____________
____________
____________
_______________________
_______________________ printed name
_______________________ signature
(signature required for admission to course)
_____ 4902 or 4903 – Senior Research/Internship
Semester to be enrolled
Credits to registered
_____
______
Course section & CRN ___________
Instructor _____________________
If more than 1 credit hour is to be earned by student, answer in the spaces
below and provide a supporting letter from the host site for the research or
internship.
Description of Research Project or Internship:
_____________________________________________________________
_____________________________________________________________
Name and Contact Information of Mentor/Supervisor for Internship/Research -
Name __________________________ Signature__________________
phone__________________
Address
______________________________________________________
______________________________________________________
E-mail
_____________________
A separate letter or e-mail will be sent to the mentor/supervisor of the research project or internship
requesting verification of successful efforts by the student.