Graduate Committee Request Form
The University of Southern Mississippi
Graduate School
118 College Drive #5024 Hattiesburg MS 39406
This PDF form is fillable. Handwritten copies will not be accepted.
Original Revised
Date:
Student Name (First, Middle, Last): Student ID:
USM Email Address:
School/Program: Degree: Emphasis:
Student's Committee
Note: Regular level 1 graduate faculty serve as members of master and specialist committees only and may not chair any committee. Regular
level 2 graduate faculty may serve and/or chair master/specialist committees, and may serve on doctoral committees. Regular level 3 graduate
faculty may serve and/or chair master, specialist, and/or doctoral committees. Associate A1 may not serve on graduate committees. A2 may
serve on Master or Specialist degree committees. A3 may serve on master, specialist or doctoral degree committees. Applicants who are
A.B.D. may not hold A3 status. A4 must be full-time USM non-tenure track teaching or clinical faculty and may serve on master, specialist,
or doctoral degree committees. A4 may chair master, specialist, or doctoral degree projects (not dissertations). Non-USM faculty may not
chair any committee.
Print Name EMPLID Leave Blank
Committee Chair:
Committee Member:
Signature:
Signature:
Signature:
Signature:
Signature:
Signature:
Committee Member:
Committee Member:
Committee Member:
Committee Member:
Student Signature:
Graduate Director/Coordinator (Print Name): Date:
Date:Graduate Director/Coordinator Signature:
Graduate School Use Only
Comments:
Graduate Dean/Dean Representative: Date:
Level:
Level:
Level:
Level:
Level:
Level:
Approved Not Approved
Select Type:
