CH4990 / CH4995 Enrollment Form

You must complete this form each semester that you enroll in undergraduate research credits.

The form must be completely filled out before sending.

Full Name:
Birth Date:
Michigan Tech Email:
Have you previously enrolled in CH4990 / CH4995?
If yes, who was(were) your research advisors?
Check one:
Semester for which you are enrolling:
Course CRN#:
 * The CRN # can be found through BanWeb.
Check one:
 * If you enroll in CH4995 (biochem majors), your advisor must be Dr. P. Murthy, Dr. M. Thompson, Dr. A. Tiwari or Dr. T. Dam.
Research advisor:
Number of credits (1-6):
Brief description of your intended project (after you have discussed it with your research advisor):
By submitting this form, you are declaring your intent to enroll in CH4990 or CH4995 for the semester and credits specified.
You will receive an email with further instructions.

Department of Chemistry

Chemical Sciences and Engineering Building
Houghton, MI 49931

Ph: 906-487-2048
Fax: 906-487-2061

Michigan Technological University

1400 Townsend Drive
Houghton, Michigan 49931-1295

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