Continued Residency Credits/Progress Plan Request

1. Student’s Name:Date

2. Current email address:

3. Year entered RMUoHP:

4. Specialty Program

Athletic TrainingHealth Promotion Wellness Orthopaedic and Sports Science

Clinical ElectrophysiologyNursing Pediatric Science

Part I: Current Progress

5. Residency Credits (CC844) requested:: B/C/D E/F/G H/I/JK/L/M N/O/P

(Please see policy 2022 for additional information about credits)

6. Chairperson’s Name (if applicable):

7. Dissertation Title/Topic (if applicable):

Activities during the Previous Year

8. Have you successfully passedboth core and specialty sections of your Qualifying Exam? Yes No If no, when do you plan to take the exam or complete a section not successfully passed?

9. Which stage of the Dissertation process have you most recentlycompleted in the past year? (Check one)

1. Formed Dissertation Committee

2. Dissertation Prospectus completed and approved

3. Dissertation Proposal Defense completed and approved

4. IRB application approved

5. Data Collection completed, analyzing results and writing up dissertation findings

6. Dissertation Final Defense approved, working on revisions for final manuscript(s)

10. Briefly describe progress made on your Dissertation (ex. “I have increased data collection from 15 to 50 subjects” or “I have finished writing chapter 3 and writing chapter 4 of the final dissertationmanuscript”).

PART II: PROGRESS/PLAN for Upcoming Year

Projected Activities during the Upcoming Year

11. At which stage of the Dissertation process do you expect to be one yearfrom now? (Check one)

1. Dissertation Committee formed

2. Dissertation Prospectus approved

3. Dissertation Proposal Defense completed and approved, submitting for IRB approval

4. RMUoHP IRB application (& other IRB application(s)) will have been approved

5. Data Collection process

6. Data Collection completed, analyzing results and writing up dissertation findings

7. Preparing for Final Defense

8. Dissertation Final Defense completed, finishing final manuscript

9 . Dissertation Final Manuscript turned in....Finished!

12. Briefly describe the progress you plan to make on your Dissertation during the next year.

13. Briefly describe possible solutions to problems you might expect with your Dissertation during the next year.

Dissertation Committee Chairperson: /

(Signature) Date

Administrative Use
Director of Research decision for request: / Yes, request approved No, request denied

Return this formto the Director of Research by email ().