Forms

Academic Support | ISO | Orientation | Postdoctoral Affairs | Registrar

Academic Support Forms

Evaluation Form	Primary User	Description
Evaluation - Annual	Student	Evaluation for PhD students to be completed by the student and the committee at least once annually (every 12 months). Policy Updated October 2012.
Evaluation - Rotation (Faculty)	Faculty	Rotation evaluation for 1st year PhD students to be completed by the rotation lab mentor. Policy Updated September 2012.
Evaluation - Rotation (Student)	Student	Rotation evaluation for 1st year PhD students to be completed by the student. Policy Updated June 2011.
Expectations Document	Primary User	Description
Expectations of Graduate Students	Student	Outlines the 14 key expectations of URMC SMD graduate students. Updated January 2011.
Expectations of Research Advisors	Faculty	Outlines the 15 key expectations of URMC SMD research advisors. Updated January 2011.

International Services Office Forms

Form	Primary User	Description
International Services Office Forms	International Students/Postdocs	Forms and information required to obtain and maintain visas for work or study in the US.
Short Term Absence Notice	International Students/Postdocs	Provides the Program Coordinator with information to assist International students with re-entry into the U.S. Updated June 2011.
Visa Delays and Denials Report Form	International Students/Postdocs	Used to provide information to the ISO regarding visa delays and denials.
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Orientation Forms for Incoming Graduate Students

Form	Primary User	Description
Employment Eligibility Verification I-9	Program Coordinator	Employment form required by the US Department of Homeland Security. Expires 8/31/12.
Federal Tax Withholding W-4	Program Coordinator	Payroll form required by the Internal Revenue Service. 2011 version.
HIPAA Training	Program Coordinator	Certifies that the student has completed HIPAA training within 30 days of matriculation. Updated February 2012.
Intellectual Property Agreement	Program Coordinator	Certifies that the student has read and understands the University's intellectual property policy and practices. Updated November 2009.
NYS Tax Withholding IT-2104	Program Coordinator	Payroll form required by New York State Department of Taxation and Finance. 05/11 version.
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Postdoctoral Affairs Forms

Appointment/Re-Appointment Forms	Primary User	Description
520 Appointment Form via HRMS	Departmental Administrator	Guide to Benefits and Job Codes for Postdoctoral Appointees
Offer Letter Template for 0093 Postdoctoral Associate Offer Letter Template for 0095 Postdoctoral Fellow Reappointment Letter Template for all Postdoctoral Appointees	Faculty	Postdoctoral appointment offer letter and reappointment letter templates. Updated April 2012. Postdoctoral Appointment Policy Guide to Benefits and Job Codes for Postdoctoral Appointees Offer/Reappointment Letter FAQs
Individual Development Plans (IDPs) and Annual Review	Primary User	Description
Annual Review	Postdoctoral Appointee	Developed by FASEB, sample annual review form to be used by postdoctoral appointees.
Career Development Plan	Postdoctoral Appointee	Developed by the Clinical and Translational Science Institute, this is another example of a development plan that a postdoc may use.
IDP by FASEB	Postdoctoral Appointee	The Individual Development Plan (IDP) concept is commonly used in industry to help employees define and pursue their career goals. This framework was developed by FASEB for postdoctoral fellows in the sciences.
myIDP by Science Careers	Postdoctoral Appointee	myIDP, by Science Careers, expands on the FASEB framework. myIDP is a unique, web-based career-planning tool tailored to meet the needs of trainees in the sciences.
SMD Annual Evaluation	Postdoctoral Appointee and Faculty	Developed by the SMD, completion of this form will satisfy the minimum requirement for Individual Development Plan and Annual Review for a postdoctoral appointee. Updated April 2013.

Registrar Forms

Exam-related Form	Primary User	Description
Academic Calendar	All	Academic calendar for graduate programs in the School of Medicine and Dentistry for the academic year 2012-2013.
Defense Committee Email Addresses	Program Coordinator	List of faculty members and approved guest members who will serve on a graduate student's final oral exam committee. Updated October 2012.
Diploma Form	Student	Used to indicate exactly how a graduate's name should appear on his/her diploma. Updated May 2013.
PhD Defense Appointment	Program Coordinator	Notification to the Dean of a scheduled doctoral defense. Instructions Updated October 2012.
Program of Study - Master's Degree	Program Coordinator	List of completed course requirements for the degree MA, MPH, MS. Updated Feb. 2012.
Program of Study - PhD Biomedical	Program Coordinator	List of completed courses and research credit hours for the PhD degree in the biomedical sciences. Updated April 2011.
Program of Study - PhD Health	Program Coordinator	List of completed courses and research credit hours for the PhD degree in the health sciences. Updated July 2011.
Program Statement on Completion of PhD Requirements	Program Coordinator	Certifies that the student has completed all PhD degree requirements. Updated June 2011.
Qualifying Exam Appointment	Program Coordinator	Notification to the Dean of a scheduled qualifying examination. Form instructions. Updated August 2012.
Thesis Registration Permission	Program Coordinator	Indicates advisor approval to submit a PhD thesis for defense. Updated April 2011.
Registration Form	Primary User	Description
Add/Drop	Student	Form updated February 2012. Add/drop form instructions 2012-13 Refund Schedule
Bursar Statement	Student	Used to notify Bursar's Office of method of payment for semester's tuition.
Non-Matriculated Financial Statement	Student	Financial statement for non-matriculated students.
Non-Matriculated Registration	Student	Course registration form for non-matriculated students. Form must be completed electronically. Updated September 2012.
Payment Agreement	Student	Student acknowledgement of financial responsibility of tuition and fees.
Student Record Form	Primary User	Description
Address Change	Student	Used to change local or permanent address. International students, see ISO Forms.
Change of Status	Program Coordinator	Submitted for changes such as degree, major, time status, termination/completion. Updated February 2012.
Course Transfer Credit	Student	Request to transfer credits based on courses completed at other colleges and universities. Form instructions \| Policy Updated February 2012.
Course Waiver	Student	Request to waive courses based on courses completed at other colleges and universities. Form instructions. Updated Feb. 2012.
Enrollment Verification Request	Student	Used to confirm enrollment status or verification of graduate degree(s) earned for employment purposes, insurance, international travel letters, etc.
Exit Interview	Student	Provides the Senior Associate Dean with graduating students' plans for the future. Updated June 2012.
Incomplete Grade Contract	Faculty	Used to notify Registrar that a student has completed all coursework except for the final exam. Updated April 2011.
Leave of Absence Request	Student	Used to request a short-term leave of absence from the degree program. Updated February 2012.
Name Change Request	Student	No form required. Simply provide the Registrar with a legal form of identification that bears your new name.
Parental Leave Request	Student	Used to request a parental leave of absence from the degree program. Policy Updated August 2011.
Supplemental Grade Notice	Faculty	Used to notify the Registrar of a change to an incompleted grade. Updated April 2011.
Transcript Request	Student	To request an official University of Rochester transcript.
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