COLLEGE OF SCIENCE GRADUATE OFFICE



SCHOOL OF MEDICINE GRADUATE OFFICE WAYNE STATE UNIVERSITY

PLAN OF WORK AND PETITION FOR CANDIDACY FOR THE GRADUATE CERTIFICATE

|INSTRUCTIONS-FILL OUT THREE COPIES, PRESENT TO ADVISOR FOR APPROVAL AND FORWARD TO OFFICE FOR GRADUATE PROGRAMS, SCHOOL OF MEDICINE |

NAME ID #

ADDRESS PHONE

MAJOR Medical Physics ADVISOR

DEGREE SOUGHT Grad Certificate DEGREE PLAN A (THESIS) PLAN B (ESSAY) √ PLAN C

G.C. PLAN OF WORK – COURES COMPLETED AND PROPOSED (Please list chronologically)

|TERM / YEAR | |COURSE |COURSE TITLE |MAJOR |MINOR COGNATE |CORE HRS. |

| |DEPT. |NO. | |HRS. |HRS. | |

| |ROC |5010 |INTRO. RADIOLOGICAL PHYS. |4 | |4 |

| |ROC |7000 |IMAGING PHYSICS I |4 | |4 |

| |ROC |7060 |RADIOBIOLOGY |2 | |2 |

| |ROC |7020 |PHYS. RADIATION THERAPY |3 | |3 |

| |ROC |7040 |DOSIMETRY |2 | |2 |

| |ROC |7070 |RADIATION SAFETY |2 | |2 |

| |ROC |7150 |RAD. ONC. ANATOMY & PHYS. | |2 |2 |

|Total hours in degree program…………………. TOTALS: |17 |2 |19 |

NOTE: Student is responsible for completing any perquisites pertaining to courses on this plan of work.

All degree requirements and course work must be completed within six years following date of first recorded grade used for degree

PETITION FOR CANDIDACY

On the basis that I have taken all entrance examinations and prerequisite courses specified, have presented my “Graduate Certificate Plan of Work”, and have given evidence of ability to pursue satisfactorily a program of graduate study, I hereby petition my advisor and the Graduate Office to be advanced to “candidate” for the Graduate Certificate.

Applicant’s Signature:_________________________________ Date:_________________

Plan of Work Approved and Candidacy recommended by:________________________________ Date:_________________

Advisor

OFFICE FOR GRADUATE PROGRAMS:

Checked by:___________________ Date:_______________ Reviewed by:___________________ Date:_______________

CANDIDACY AUTHORIZED BY GRADUATE OFFICE:__________________________________ Date:________________

Rev. 5/25/2011 Dean/Director

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