1.	Full Name:*

2.	Student ID number*

3.	UNCW e-mail*

4.	Term*
	--Please Select--FallSpringSummer ISummer II

5.	Year*
	--Please Select--20082009201020112012

6.	Department Prefix*
	--Please Select--BIO

7.	Course Number*
	--Please Select--699 Dissertation698 Research

8.	Course Credit: maximum 6 hrs in 698, maximum 12 hrs in 699 *
	--Please Select--123456789101112

9.	Dissertation Advisor: (First and Last Name)*