Fillable UMMC MDPHD PROGRAM FORM

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UMMC MDPHD PROGRAM FORM

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Form Version 01.19
UMMC MD/PhD Program
Graduate Program Selection Form
Student Name (print): Date:
Please select the Graduate Program in which you will perform your thesis work:
Biomedical Sciences
Cell and Molecular Biology
Clinical Anatomy
Experimental Therapeutics and Pharmacology
Microbiology and Immunology
Neuroscience
Physiology and Biophysics
I understand that, in order, to be eligible for the PhD degree I must complete all
coursework, qualifying exams, and thesis dissertation requirements in accordance
with the School of Graduate Studies and that of my selected Department or Program.
Student’s Signature
Graduate Program Director:
I acknowledge that I have discussed the specific requirements of our Graduate
Program with this MD/PhD student. This student will be added to all
Departmental/Program communications, including Departmental/Program mailing
and email lists as well as our Graduate student webpage. The student will be required
to attend all Departmental/Program activities, including but not limited to our
seminar and journal club series.
APPROVED BY: Graduate School (please sign and print your name) Date
APPROVED BY: Graduate Mentor (please sign and print your name) Date
APPROVED BY: MD/PhD Program Director Date
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UMMC MDPHD PROGRAM FORM

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Completed 27 February 2020

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