A#5!(1)!
Revised!11/17!
DIVISION'of'ACADEMIC'AFFAIRS'
School'of'Graduate'Studies'
NOMINATION OF THESIS EXAMINING COMMITTEE
Date _______________
_________________________________ ___________________________________________
Student’s Full Name (Last, First, Middle) Student’s Identification Number
_________________________________ ___________________________________________
Address Graduate Program
________________________________ ___________________________________________
City, State, ZIP Degree Sought
________________________________ Initial Term (GS Use only) _____________________
(Area Code) Telephone
Is the title of the thesis abstract attached? YES [ ] NO [ ]
Expected oral examination date: ___________________
An oral examination may not be held until the Graduate School approves the recommended committee.
Research Assurance:
Are human subjects involved in the research? Yes No
(If yes, please attach a copy of the approval from a University Institutional Review Board)
Are vertebrate species (birds, mammals, fish, etc.) involved in the research? Yes No
(If yes, please attach the UMES Animal Care and Use Committee form, showing protocol number and approval date)
Are bio-hazardous materials, biological or chemical, or recombinant RNA/DNA involved in this research? Yes No
(If yes, please attach a copy of the approval from the appropriate university committee)
Theses Examining Committees must have a minimum of three (3) members. Two of these members must be a
Regular or Associate member of the UMES Graduate Faculty. The chair of these committees must be the student’s
advisor and must be a Regular or Associate member of the Graduate Faculty.
Nominated Committee
Name
Program/Department/
Place of Employment
Graduate Faculty Status (check one)
(Regular) (Associate) (Special)
Chair
Dean’s Representative
(Doctoral Committee only)
A#5!(1)!
Revised!11/17!
__________________________________________ __________________________
Advisor (Printed Name/ Signature) Date Telephone/ Email
__________________________________________ __________________________
Graduate Program Director [if required]
Date Telephone/ Email
Graduate School Approval of the Examining Committee:
1. As nominated [ ]
2. As amended [ ] ( Name(s) added below)
3. As revised [ ] (after the original nomination list)
_______________________________________ ____________________________
Dean of Graduate School Date
Please return this form to:
School of Graduate Studies
University of Maryland Eastern Shore
Engineering and Aviation Sciences Complex, Suite 3046,
Princess Anne, Maryland - 21853.
Phone: 410-651-6507
Fax: 410-651-7571
Email: graduatestudies@umes.edu
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