Specialty Project Contract of Learning Section 1: Introduction and Identifying Information

Instructions

The ? icon by a question is an indicator that important and helpful information is available - please review these when answering questions

Detailed information is available on the Clinical Distinction Website for all of the questions asked on this form. This form can be reviewed and changed prior to submission. During the process of asking for approval from your faculty sponsor both you and the sponsor will have the opportunity to make further revisions.

Once the contract of learning is approved, any changes to the project should be noted in the evaluation portion, rather than editing the contract. In some cases a student might want to modify the project in advance of completing the work -this should be discussed with the sponsor or a CD advisor.

Enter your Student ID: Note most students have an ID that starts T00 followed by 6 digits. Some have T000XXXXXX. Enter your full ID where the placeholder text is. *

Enter your TOURO email *

First Name *

Last Name *

Enter your Sponsor's First Name *

Enter your Sponsor's Last Name and title (D.O., M.D. etc) *

Enter your sponsor's email *

Gender by which you identify * 🛈

Male

Female

Gender Fluid

Which course are you completing *

CLIN 717 CD I

CLIN 718 CD II

Create a title or list the subject of your specialty project for Clinical Distinction * 🛈

Start date of Clinical Distinction rotation: * +

End date of Clinical Distinction rotation: * 🛈 +

Select the design of your project. The web page with information on what the different design options are is:Design Options * 🛈

Basic

Longitudinal

If you are doing a longitudinal Clinical Distinction, what is the end date of your project? ( as a reminder, you should have included this date in your rotation request form. If you did not, please notify the third year coordinator and the curriculum coordinator immediately) 🛈 +