INSTRUCTIONS: This form is submitted the semester in which Qualifying Examinations are taken. It is
used to certify the completion of all degree requirements except the dissertation and signifies eligibility
to begin work on the dissertation. Complete the student information, then take the form to your Advisor
and Program Director for signatures. Your Program Director will submit the form to the Office of
Research and Graduate Studies for approval.
Name Student ID
School or College
ontact Information
Local Address
Permanent Address (if different)
Phone Email (UIW)
Other Email
Successful completion of written and oral examination.
Application for graduation filed at Registrar’s Office with an anticipated graduation date at least two
years from filing date.
Graduation audit, which confirms 57 hours of coursework under an approved degree plan.
Evidence of participation in two Research Symposia.
Evidence of one proposal submitted for presentation at a Research Symposium.
Approval of Admission to Candidacy
Advisor Date
Program Director Date
Graduate Studies Date
tribution: Program Director, Advisor, Student, ORGS
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