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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:	@mtu.edu
Phone:
Have you previously enrolled in CH4990 / CH4995?	Yes No
If yes, who was(were) your research advisors?
Check one:	This is a continuing project This is a new project
Semester for which you are enrolling:	-------20132018Spring 2013Summer 2013Fall 2013Spring 2014Summer 2014Fall 2014Spring 2015Summer 2015Fall 2015Spring 2016Summer 2016Fall 2016Spring 2017Summer 2017Fall 2017
Course CRN#:
	* The CRN # can be found through BanWeb.
Check one:	CH4990 CH4995 *
	* 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:	N/A Bates, DallasBi, LanrongBooth, Gregcarroll, scottCharlesworth, PaulChesney, DavidCornilsen, BahneDam, TarunFang, ShiyueGrace, CelineGreen, SarahHeiden, PatriciaLiu, HaiyingLuck, RudyMazzoleni, LynnMurthy, PushpalathaThompson, MartinTiwari, AshutoshValenzano, Loredana
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.

I agree