Request to Serve on Thesis or Dissertation Advisory
Committee
Date:
Department:
Faculty Position:
ID Number:
Instructor Name:
College:
Thesis Advisor:
Thesis/Dissertation Title:
Student Name:
Briey state experience and qualications:
A CURRENT CURRICULUM VITAE (CV) MUST ACCOMPANY THIS FORM.
ATTACH CV TO EMAIL AFTER SIGNING BELOW.
Thesis/Dissertation
Advisor Signature:
Chair Signature:
College Dean Signature:
Form must be submitted to the Ofce of Admissions, Records and Registration after electronic signatures are completed.
Please ensure CV is attached to the generated email.
ID Number:
ID Number:
The Department and College have reviewed this person’s credentials and approve him/her to serve on the committee
for the thesis/dissertation listed above.
12/16
SUBMIT
SUBMIT
SUBMIT
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