1/21 GS This form is available on our website: www.pdx.edu/gradschool/forms GO-16D
APPOINTMENT OF DOCTORAL DISSERTATION COMMITTEE
The doctoral program must submit this form to the Graduate School at least 6 weeks in advance of the estimated date of proposal defense.
The dissertation committee must consist of four to six PSU faculty members: the dissertation chair and a minimum of three and a maximum
of five members. The chair of the dissertation committee must be regular, full-time PSU instructional faculty, tenured or tenure-track, assistant
professor or higher in rank; the other three to five committee members may include adjunct or fixed-term faculty and/or members of the
OHSU faculty. If it is necessary to go off-campus for one committee member with specific expertise not available among PSU faculty, a
curriculum vitae (CV) for that proposed member must be presented with the GO-16D form. This off-campus member may substitute for one
of the three to five regular committee members. All committee members must have doctoral degrees.
At the discretion of the doctoral program, the designation of co-chair can be requested for one member of the committee. The designation of
co-chair recognizes the significant academic advising role of the committee member, but oversight of the process and procedures remains
with the chair. To request this designation, write “co-chair” below next to the appropriate faculty member’s name.
Students must be registered for a minimum of 1 graduate credit in the term they are defending their dissertation proposal.
THE DISSERTATION COMMITTEE MUST BE APPROVED BY THE GRADUATE SCHOOL BEFORE THE PROPOSAL DEFENSE.
Any committee changes, for any reason, must be approved in advance by the Graduate School.
Name _____________________________________________________________ PSU ID# _____________________________
PSU E-mail (print clearly)_____________________________________________ Daytime phone _________________________
Degree (Ph.D., Ed.D.) ____________________ Major ____________________________________________________________
Dissertation title or topic ____________________________________________________________________________________
Will Human Subjects be involved in any way? Yes No (must select one)
Estimated date of proposal defense ____________________ Do not schedule proposal without GS approval of the committee.
COMMITTEE MEMBER DEPARTMENT
Chair: _____________________________________________________ ______________________________________
_____________________________________________________ ______________________________________
_____________________________________________________ ______________________________________
_____________________________________________________ ______________________________________
_____________________________________________________ ______________________________________
_____________________________________________________ ______________________________________
_____________________________________________________ _______________________________________
NO PROPOSAL DEFENSE SHALL BE VALID WITHOUT A DISSERTATION COMMITTEE APPROVED BY
THE GRADUATE SCHOOL.
_____________________________________ ___________________________________________ ___________
Dissertation Chair (printed name) Dissertation Chair (signature) Date
_____________________________________ ___________________________________________ ___________
Doctoral Program Director (printed name) Doctoral Program Director (signature) Date
To be completed by the GRADUATE SCHOOL
Dean of the Graduate School _________________________________________________ Date ______________________
