M
M
e
e
d
d
i
i
c
c
a
a
l
l
C
C
o
o
l
l
l
l
e
e
g
g
e
e
o
o
f
f
W
W
i
i
s
s
c
c
o
o
n
n
s
s
i
i
n
n
G
G
R
R
A
A
D
D
U
U
A
A
T
T
E
E
S
S
C
C
H
H
O
O
O
O
L
L
O
O
F
F
B
B
I
I
O
O
M
M
E
E
D
D
I
I
C
C
A
A
L
L
S
S
C
C
I
I
E
E
N
N
C
C
E
E
S
S
DEGREE APPLICATION
MONTH__________________ YEAR ______________
Instructions:
This form must be completed and submitted AFTER the student has completed the
dissertation defense / final thesis successfully.
CANDIDATE: ________________________________________________________________
LAST FIRST MIDDLE
DEPARTMENT/
PROGRAM: ________________________________________________________________
DEGREE EXPECTED: ________ MA, MS, MPH, PHD
TITLE OF DISSERTATION, THESIS, PAPER or PROJECT PROPOSAL (circle one): ____________________
____________________________________________________________________
____________________________________________________________________
RECOMMENDED BY:
ADVISOR ______________________________________________________
PRINTED NAME
______________________________________________________
SIGNATURE DATE
APPROVED BY:
PROGRAM DIRECTOR ___________________________________________________
PRINTED NAME
____________________________________________________________________
SIGNATURE DATE
___________________________________________________
DEAN DATE
_____________________________________ _____________________________
SIGNATURE OF CANDIDATE DATE
(revised 2011)
