ARKANSAS TECH UNIVERSITY
DISSERTATION COMMITTEE MEMBER CHANGE FORM
STUDENT NAME: _______________________________________________ T NUMBER: _____________________________
STUDENT SIGNATURE: ___________________________________________ GRADUATION DATE: _______________
EMAIL ADDRESS: ________________________________________________________ PHONE: ________________________
DISSERTATION TOPIC:
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COMMITTEE BEFORE CHANGES: CHANGE STATUS:
Member Name: ________________________________________________________ ☐ Remaining ☐ Leaving
Member Name: ________________________________________________________ ☐ Remaining ☐ Leaving
Member Name: ________________________________________________________ ☐ Remaining ☐ Leaving
Member Name: ________________________________________________________ ☐ Remaining ☐ Leaving
Member Name: ________________________________________________________ ☐ Remaining ☐ Leaving
NEW COMMITTEE MEMBERS(S):
ALL COMMITTEE MEMBERS MUST HAVE GRADUATE FACULTY STATUS
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.
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Printed Name Signature Date
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Printed Name Signature Date
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Printed Name Signature Date
SIGNATURES OF APPROVAL:
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Program Director Date
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Dean of the Graduate College Date
