Major
Title
Course
Number
Credit Grade
Equiv. TTU
Course No.
APPROVED ADVISORY COMMITTEE:
date Chairperson
date Member
date Member
date Member date
date Member
date Member
date Member date
Do you anticipate using Human Subjects in your research? YES NO
If yes, IRB approval is required one semester prior to graduation. Contact your advisor for more information.
Name
Transfer From and/or
Background Courses
PH.D. EXCEPTIONAL LEARNING
PROPOSED PROGRAM OF STUDY
Date
Completed
or To Be
Completed
T. No.
* Enter courses in following order:
1. Background courses
2. Primary Area courses
3. Related Area courses
**Enter name of university where courses were taken
***Practicums, internships, professional activities, etc.
COURSES*
TRANSFER / BACKGROUND
CREDIT INFORMATION
College of Graduate Studies Designee
Associate Dean/Director for Doctoral Programs
date
Departmental Chairperson
Total Hours: 7000 level 6000 level 5000 level
Brief Description of Proposed Research
List requirements and give basis for choice if other:
Other Requirements***:
Final GPA:__________
8 years expires end of ________ __________
(term) (year)
HANDWRITTEN FORMS WILL NOT BE ACCEPTED
General Core (13 Credit Hours)
Concentration (23 - 24 Credit Hours)
Guided Electives (6 - 7 Credit Hours)
Research Component ( 21 Credit Hours)
Dissertation Research (15 Credit Hours)
Appointment of Advisory Committee
I hereby request that the following members of the Graduate Faculty be appointed to serve on my Graduate Advisory
Committee:
Name (please type in committee names)
________________________________________________________________
Chairperson
________________________________________________________________
Member
________________________________________________________________
Member
________________________________________________________________
Member
________________________________________________________________
Member
________________________________________________________________
Member
________________________________________________________________
Member
Student’s Signature _______________________________________________________ Date ________________________
Student T No. ____________________________________________________
Approved ____________________________________________________________________________________________
Departmental Chairperson
date
Approved ____________________________________________________________________________________________
Associate Dean/Director for Doctoral Programs
date
Approved ____________________________________________________________________________________________
College of Graduate Studies Designee
date