Name:
Student ID Number:
Mailing Address:
City: State:
Zip Code:
Daytime Phone:
Evening Phone:
E-mail Address:
Did a particular faculty member recruit you to this institution? Yes No
Name of faculty member:

How did you hear about this program:


Do you intend to complete:
Thesis (Plan A)
Non-Thesis (Plan B)
Coursework Option (Plan B)

Thesis Option

If you plan on doing a Thesis, what is the project topic?


Please describe the protocol you wish to pursue:

Do you think this project will require approval for human subject involvement from CMU and your data collection site?
Yes   No

Will HIPPA regulations be an issue? Yes   No

When do you plan to start and finish your Plan B paper or Thesis?

An advisor will be assigned to you based on availability and interest.

Plan B Option

If you plan on doing a Plan B paper, what is the topic?

Do you intend to do the Plan B paper in a classroom format? Yes   No

If not, do you intend to work with a faculty member individually? Yes   No

If working with a faculty member individually, please describe the intended outcome and whether or not you intend to pursue publication of your Plan B paper.

An advisor will be assigned to you based on availability for non-classroom Plan B work.

Coursework Only Option

Do you plan on completing a Plan B Coursework option? Yes   No

If you plan on completing a Plan B (coursework only) option, please explain why.

Are you aware of the credit requirements for coursework students? Are you aware that dietetic internship credits are non-transferable for this option?
Yes   No
Program coordinator or other faculty/staff will be assigned to you as your advisor.

For questions, contact:
Candace Maylee
Assistant Coordinator HEV Graduate Programs
mayle1ce@cmich.edu
Phone: 989-774-2613
Fax: 989-774-2435