1.
2.
Year
Time:
Request to Schedule Dissertation
Defense for the PhD Degree
Graduate Academics
INSTRUCTIONS:
This form is to be completed by the Chairperson of the PhD Guidance Committee and then sent to the Office of the Associate
Dean for Graduate Academics (see Prof. Jose Ulerio in RH412A) at least 2 weeks prior to the scheduled defense date.
PLEASE INCLUDE A COPY OF THE ABSTRACT WITH THIS APPLICATION.
When this form is approved, copies of a notice, entitled "Notice of Scheduled Final Examination for the PhD Degree" will be
sent to the student, the committee members, the department head, and the Guidance Committee Chairperson for distribution to
select members of the faculty as an invitation to attend the exam.
Email Address
Telephone Number
Net ID
STUDENT INFORMATION:
First Name
Last Name
Univ ID
Semester & Year Passed Qualifying Exam
GUIDANCE COMMITTEE:
Academic Home Department
Academic Major
Chairperson Email
Dissertation Adviser Dissertation Adviser Email
Dissertation Title
Major
Date Satisfied
Minor (if applicable)
Committee Member#3 Email
Committee Member#4
Committee Member#4 Email
Committee Member#5 Email
Committee Member#6
Committee Member#6 Email
Committee Member#1 Email
Graduate Academics
Signature
STUDENTS: DO NOT WRITE BELOW THIS LINE
ADMINISTRATIVE ACTION:
Jose Ulerio, Operations Manager
Chairperson's Name
Signature
Date
REQUEST TO SCHEDULE EXAMINATION:
Date of Examination:
Location:
Committee Member#2
Committee Member#2 Email
School
Date
Previous Degrees (e.g.,
BS
Electrical Engineering)
)
Country
Date Satisfied
I have verified the above information and hereby request that the dissertation defense and the final examination for the PhD for the above named
candidate be scheduled as follows:
____________________
_
N
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