SYRACUSE UNIVERSITY
Department of Biology
Proposal for BCM 460
Introduction to Biochemical Research
This form should be completed with input by both the student and the faculty member in the same
sitting. Please remit completed form with student and faculty advisor signatures to Deborah Herholtz in
the Biology Department (Life Science Building, Room 110) for processing. The department chair will sign
and the student will be able to register once the proposal has been completed and approved.
Part I
STUDENT: Please supply the following information and then arrange to meet with your faculty advisor to
complete and sign Part II of this form.
Name: _____________________ SUID: _____________________ Email: _____________________
College: _____________________
Major: Chemistry ________
Campus Address: ________________________________________
Biochemistry ________
Phone: _________________
Semester: Fall _____ Spring ______ Summer: Session I _______ Session II ______ Year ________
Number of Credits (1-4): ___________ Name of Faculty Advisor: ________________________
Part II
FACULTY: Please complete items 1-8. The student must return this form to Deborah Herholtz for further
processing.
1. Title and Objectives of Study or Experience (including previous and related course study):
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
2. Procedures of Study or Nature of Experience:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
3. Nature of Contact with Faculty Sponsor or Supervisor:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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4. Criteria for Assessing Student Performance:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
5. Is Specialized Safety Training (X-ray radiation, bloodborne pathogens, etc.) beyond that provided
by standard EHSS training necessary for this research?
Yes No
6. Are human subjects part of the proposed research?
a. If yes, is there an IRB approved protocol in place?
7. Will this research be performed on the SU campus?
Yes
No
Yes No
Yes
No
Yes
No
Yes
No
a. If elsewhere, please specify: _____________________
8. Are animal subjects part of the proposed research?
a. If yes, is there an IACUC approved protocol in place?
I have read this document and agree to the scope and expectations of the research. I further agree to
submit the final product at the end of the semester to the Department of Biology (Deborah Herholtz –
[email protected]). Examples include: oral presentation slides, manuscript or draft, progress report or
similar. These documents will not be publicly distributed, but will be archived by the Department for
our records.
_______________________________
Student Signature
________________________
Date
_______________________________
Faculty Advisor Signature
________________________
Date
_______________________________
Department Chair Signature
________________________
Date
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