External Committee Member Nomination 1
External Committee Member Nomination Form
Use this form to nominate an external committee member who a) is an expert in a given field, and b) is not
employed at UIW as a faculty member, and c) will serve only on a thesis or dissertation committee.
Membership is valid only once and only for the student specified.
Instructions: Committee Chair should complete front and back of form, attach nominee’s CV,
and send to Program Director, who sends to Office of Research & Graduate Studies for decision.
STUDENT INFORMATION
Student ID:
School or College:
Name of Student:
Program:
Name of Nominee:
Present Rank:
Academic Training (chronological order, highest degree listed first):
College or University Dates Attended Degree and Date Awarded
Teaching, Professional, and Research Experience Relevant to the Topic (chronological order, most
recent positi
on listed first):
1.
2.
Institution, Company, Other Empl
oyer, Rank/Position and Dates, Graduate Courses Taught
Relevant to the Topic (list by title and number):
1.
2.
NOMINEE INFORMATION
External Committee Member Nomination
June 2018
2
Date:
Areas of Expertise:
(a) Primary (b) Secondary
a)
b)
Last Two Peer-Reviewed, Published Manuscripts:
1)
2)
Program Director Recommendation
(signature)
(print name)
Comments:
Representative, Research and Graduate Studies
(signature)
Date:
Approved Denied
APPROVAL
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