Proposal / Final Defense Results (Pass/Fail)
Degree: Ph.D. Leadership Studies
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Student Name
*
First Name
Last Name
Suffix
Student ID
*
Student Email Address
*
example@example.com
Student Signature
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Student Signature Date
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Completion of this form confirms the examination for the above Student. Examination:
Dissertation Oral Defense-Proposal
Dissertation Oral Final
Result:
Pass
Fail
Dissertation Chair Name
*
Dr.
Prefix
First Name
Last Name
Dissertation Chair Email
*
example@example.com
Dissertation Chair Signature
*
Dissertation Chair Signature Date
*
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Month
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Day
Year
Date
First Committee Member Name
*
Dr.
Prefix
First Name
Last Name
First Committee Member Email
*
example@example.com
First Committee Member Signature
*
First Committee Member Signature Date
*
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Month
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Day
Year
Date
Second Committee Member Name
*
Dr.
Prefix
First Name
Last Name
Second Committee Member Email
*
example@example.com
Second Committee Member Signature
*
Second Committee Member Signature Date
*
-
Month
-
Day
Year
Date
Program Director
Program Director Email
example@example.com
Program Director Signature
*
Program Director Signature Date
*
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Month
-
Day
Year
Date
Submit
Should be Empty: