Request to Form Thesis or Dissertation Committee
(Three members required for thesis; minimum of ve members required for dissertation)
Date:
Department:
Student ID Number:
Student Name:
College:
Advisor:
Member:
Member:
Member:
Member:
Member:
Member:
Member:
Email:
Email:
Email:
Email:
Email:
Email:
Email:
Email:
Degree:
Graduate Program
Director Signature:
Chair Signature:
College Dean Signature:
Form must be submitted to the Ofce of Admissions, Records and Registration after electronic signatures are completed.
Please ensure any relevant additional documentation is attached to the generated email.
11-2017
SUBMIT
SUBMIT
SUBMIT
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