Certificate in Gerontology

UW INSTITUTE ON AGING

REQUEST TO SUBSTITUTE A COURSE

Specialist in Gerontology Certificate Program

Course Instructor: This is a request to substitute a course for the Specialist in Gerontology Certificate Program by either using a course currently listed as an elective on the program handout to fulfill a core requirement or by using a course that is not listed on the program handout at all to fulfill a core or elective requirement. If you wish to approve this request, please complete #1, #2, and/or #3 (as appropriate) below, sign and return this form within the first two weeks of classes. The student must also sign.

Please review the attached program handout and definition of core and elective courses, field work, internships, practica, and independent study before completing this form.

Student Name Instructor Name

Course Title and Number

1. I recommend that this course be counted as follows for this student’s completion of the certificate program. CHECK ONLY ONE

A. This course is listed as an elective on the program handout. If the work described in No.2 below is completed, it is my opinion that this course can fulfill the CORE requirement in the biomedical OR psychosocial category (Please choose one). B. This course is not listed anywhere on the program handout. If the work described in No. 2 below is completed, it is my opinion that this course can fulfill a CORE requirement in the biomedical OR psychosocial category (Please choose one). C. This course is not listed anywhere on the program handout. If the work described in No. 3 below is completed, it is my opinion that this course can fulfill an ELECTIVE requirement.

2. If lines A or B above are checked, please complete the following:

Please list a minimum of two activities in addition to lectures that the student can focus on gerontology, geriatrics, or life course studies, e.g., papers, presentations, projects, group activities, optional readings, or other course activities (please be specific).

3. If line C above is checked, please complete the following: Explain gerontology, geriatrics, or life course content.

Instructor Signature Date Student Signature Date

Return to the Institute on Aging, 2245 MSC, 1300 UniversityStudent Avenue, Name Madison, (please WI print)53706; [email protected] Questions: Sheila Hessman, [email protected], 263-6404 ______ua/ioa/certificatephdprograms/certificateprogram/ letter&formtemplates/coursesubstitution 3/23/10 ______Student Signature/Date Core Requirement: Course provides basic understanding of a subject central to gerontology, geriatrics, or life course studies. Gerontology content may take the form of topics covered in course materials as well as assigned projects such as term papers and presentations.

Elective Requirement: Course includes some aging content as follows: lectures that address subjects central to gerontology, geriatrics, or life course studies OR overall course content that can be applied to gerontology, geriatrics, or life course studies, as well as other disciplines.

Field Work/Internships/Practica

 Maximum of 6 credits can be counted as ELECTIVES only.  Supervising instructor must complete a course substitution form which can be obtained from the IOA office. The IOA will determine if the course can be substituted.  If internship credits are in major department, they count toward the 9-credit maximum in any single department. Independent Study Credits

 Maximum of 6 credits of UW-Madison independent coursework (399, 699, 799, 999) may count as an elective OR core requirement with appropriate approval.  A course substitution form must be completed by the supervising instructor. The form can be obtained from the IOA office. The IOA will determine if the course can be substituted

Attachment: Current course list