TO: Dean of Graduate Studies
SUBJECT: Request for Appointment of Advisory Committee
DATE: ___________________________________
I certify that I have satisfactorily completed six semester hours of graduate work and hereby request that the following
members of the Graduate School Faculty be appointed to serve on my Graduate Advisory Committee:
Name (please print) Signature Date
__________________________________ ________________________________________________________________
Chairperson
__________________________________ ________________________________________________________________
Member
__________________________________ ________________________________________________________________
Member
__________________________________ ________________________________________________________________
Member
__________________________________ ________________________________________________________________
Member
__________________________________ ________________________________________________________________
Member
__________________________________ ________________________________________________________________
Member
Student’s Signature _______________________________________________________ Date ________________________
Student ID/ T No. ____________________________________________________
Student’s Address __________________________________________________
__________________________________________________
Approved ____________________________________________________________________________________________
Departmental Chairperson date
Approved ____________________________________________________________________________________________
Associate Dean/Director for Doctoral Programs date
Approved ____________________________________________________________________________________________
Coordinator of Graduate Studies date