Ph.D. Change of Advisor Request Form
Student Information
Student ID
*
Student Email
*
example@example.com
Title
*
Mr.
Mrs.
Ms.
Student Name
*
Degree
*
Undergraduate
Masters
Doctoral
Contact Number
*
Program
*
Artificial Intelligence and Computer Engineering
Artificial Intelligence Innovation
Electrical and Computer Engineering
Technology and Creative Innovation
Current Semester
*
Fall
Spring
Summer
Year
*
Expected Completion Semester/Year
*
Advisor Information
Current Advisor’s Information
Current Advisors Name
*
Email address
*
example@example.com
Requested Change
New Advisors Name
*
Email address
*
Reason for Change
*
Academic Focus Alignment
Research Interest Alignment
Other
Please confirm the following by checking box
*
I hereby request a change of advisor as outlined in this form.
Signature of Student
*
Date
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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