ARKANSAS TECH UNIVERSITY
DISSERTATION COMMITTEE APPOINTMENT FORM
STUDENT NAME: _________________________________________________ T NUMBER: ___________________________
STUDENT SIGNATURE: ____________________________________________________________________________________
EMAIL ADDRESS: ________________________________________________________ PHONE: ________________________
ANTICIPATED GRADUATION DATE: _____________________________________________________________________
GENERAL TOPIC OF DISSERTATION: __________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
ALL COMMITTEE MEMBERS MUST HAVE GRADUATE FACULTY STATUS
COMMITTEE CHAIR:
My signature indicates I agree to provide the graduate student with the information and direction necessary to
prepare an acceptable document for presentation to the Graduate College and the fulfillment of all doctoral degree
requirements.
__________________________________________ __________________________________________ __________________________
Printed Name Signature Date
DISSERTATION COMMITTEE:
My signature indicates I agree to provide the graduate student with the information and direction necessary to
prepare an acceptable document for presentation to the Graduate College and the fulfillment of all doctoral degree
requirements.
__________________________________________ __________________________________________ __________________________
Printed Name Signature Date
__________________________________________ __________________________________________ __________________________
Printed Name Signature Date
__________________________________________ __________________________________________ __________________________
Printed Name Signature Date
__________________________________________ __________________________________________ __________________________
Printed Name Signature Date
SIGNATURES OF APPROVAL:
_____________________________________________________________________________________ ___________________________
Program Director Date
_____________________________________________________________________________________ ___________________________
Dean of the Graduate College Date