GS Thesis Proposal Registration

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Thesis Proposal Registration Form

DETAILED INSTRUCTIONS FOR THE THESIS PROPOSAL CAN BE FOUND IN THE GRADUATE SCHOOL STUDENT HANDBOOK

Student Information

Student Name*

First Name

Last Name

Student Email*

Phone

Life Number*

Dissertation Advisor (Preceptor)*

First Name

Last Name

Dissertation Advisor (Preceptor) Email

Add another Dissertation Advisor

Dissertation Advisor (Preceptor) 2

First Name

Last Name

Dissertation Advisor (Preceptor) Email 2

Add another Dissertation Advisor

Dissertation Advisor (Preceptor) 3

First Name

Last Name

Dissertation Advisor (Preceptor) Email 3

Committee Chair Name*

First Name

Last Name

Committee Chair Email*

Program*

PhD MD/PhD

MTA

Thesis Proposal Date/Time*

Thesis Proposal Location*

Thesis Proposal Title*

List Committee Members

Please list your Committee Chair Followed by the voting members of your Thesis Advisory Committee below.

Kindly note your Dissertation Advisor (Preceptor) is not a voting member of the committee.

Committee Chair Name (Voting Member #1)*

First Name

Last Name

Committee Chair Email (Voting Member #1)*

Voting Committee Member #2*

First Name

Last Name

Voting Committee Member #2 Email*

Voting Committee Member #3*

First Name

Last Name

Voting Committee Member #3 Email*

Voting Committee Member #4

First Name

Last Name

Voting Committee Member #4 Email

Voting Committee Member #5

First Name

Last Name

Voting Committee Member #5 Email

Voting Committee Member #6

First Name

Last Name

Voting Committee Member #6 Email

Dissertation Advisor (Preceptor) Approval

Dissertation Advisor (Preceptor) Name

First Name

Last Name

I approve

Yes No

Dissertation Advisor (Preceptor) Approval 2

Dissertation Advisor Name

First Name

Last Name

I approve

Yes No

Dissertation Advisor (Preceptor) Approval 3

Dissertation Advisor (Preceptor) Name

First Name

Last Name

I approve

Yes No

Committee Chair Approval

Committee Chair Name

First Name

Last Name

I approve

Yes No