Summary: 21 Request for Prior Approval of Practicum or Research Project| UGA Institute of Gerontology
Request for Prior Approval of Practicum or
This form must be submitted prior to enrolling in a practicum or beginning a research project in order for the
activity to apply to the Graduate Certificate of Gerontology. This policy applies to all students who complete the
Graduate Certificate, regardless of whether the activity is done through their primary academic department or
the Institute of Gerontology. Please return the completed application to Assistant Director, Institute of
Gerontology, 255 E. Hancock Ave., Univ. of Georgia, Athens, GA, 30602-5775.
Student's Name Date
Telephone (Work) (Home)
Please briefly describe the project that you wish to apply toward the practicum or research requirement for the
Graduate Certificate of Gerontology.
Please state exactly what you will do, and if a practicum, note where and how many hours per week you will
work. (Use additional pages, if necessary.)
Who will supervise the above project (both on-site and UGA faculty member, if a practicum; UGA faculty
member only for research)?