Office of Graduate Studies
Ed.D / Ph.D.
Intent to Defend Dissertation
Student ID #: Date:
Last Name: First: MI:
Address: City: ST: Zip
Phone: Email:
Program of Study (please check one area only):
Ed.D Note Concentration:
Pre-Kindergarten – Grade 12 Educational Leadership
Community College / Postsecondary Educational Leadership
Ph.D. List degree title or department name:
Semester and year in which the Dissertation Defense will be initiated:
Fall Spring Summer
List the proposed committee members and briefly state why you selected them or what role they will play in assisting
you in your proposed area of research:
Chair Person: Department:
Reason:
Member # 1: Department:
Reason:
Member #2: Department:
Reason:
To the best of my knowledge the information provided is correct and I have completed the qualifying exam for
candidacy. In signing this document, I agree to the public notification of the defense and the invitation for the campus
community to attend the defense.
Student Signature: Date:
Return this form to: California State University, Sacramento
Office of Graduate Studies
Riverfront Center, Room 206
6000 J Street
Sacramento, CA 95819-6112
OFFICE OF GRADUATE STUDIES USE ONLY
Approved Denied
Dean of Graduate Studies Date
Comments:
