Office of Graduate Studies
Ed.D / Ph.D.
Intent to Take Qualifying Exam
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 Doctoral Qualifying Exam 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: De
artment:
Reason:
Member # 1: Department:
Reason:
Member #2: Department:
Reason:
To the best of my knowledge, the information provided is current and I have completed all of the requirements to take
the qualifying examination for candidacy.
Student Signature: Date:
Attach to this form an abstract of your proposed research or a general description of your research are and proposed
methods (do not exceed one (1) page) and return 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:
