Fillable Masters-Clearance-Form.Dept.NEW MASTER’S CLEARANCE INFORMATION

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Masters-Clearance-Form.Dept.NEW MASTER’S CLEARANCE INFORMATION

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MASTER’S DEGREE CLEARANCE FORM (DEPARTMENT)
(print or
type)
Name: Student ID:
Prior Name(s) used while attending Fresno State:
Program Entry Date: Program Completion Date:
First Year Field Placement Agency:
Second Year Field Placement Agency:
CULMINATING EXPERIENCE
Please check off appropriate box and fill in corresponding information below: THESIS PROJECT
TITLE:
CHAIR:
READERS(S):
ADDRESS (AFTER GRADUATION OR PERMANENT ADDRESS)
Street Address City/State Zip
Phone
Cell Home Other
PLACE OF EMPLOYMENT AFTER GRADUATION (IF KNOWN):
Agency Name Street Address
City State Zip Phone
Please attach a copy of the project/thesis abstract with identifying information (Title, Author,
Readers’ Names, Year). No more than one typed page.
NOTE: Graduate Degree Clearance form will not be submitted to the Graduate Studies office until
this form and a copy of the abstract are received by the Social Work Education Department.
Master’s Degree Clearance Form (Department)
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Masters-Clearance-Form.Dept.NEW MASTERS CLEARANCE INFORMATION

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Completed 31 May 2020

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