Results of Qualifying Examination
____________________________________________ ____________________________
Student’s Name Ph.D. Degree Program
____________________________________________ ____________________________
Student’s ID Number Student’s Advisor
Advisor’s Home Department/Program: ________________________
Date of Exam: _______________________________________________
Passed: □ Conditional Pass*: □ (see attached explanation) Failed: □
Date of Conditional Exam: ______________________________________
Passed: □ Failed: □
Date of Exam (2
nd
attempt): ______________________________________
Passed: □ Failed: □
Date of Final Outcome: _________________________________
(could be the same Date of Exam)
Advisor: ______________________________________________ __________________
(signature) (date)
Montana Tech Campus Director: ___________________________ __________________
(signature) (date)
Dean of Graduate School: _____________________________________ __________________
(signature) (date)
*any conditional pass will require a written explanation signed by the student and the advisor
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