REQUEST FOR DISSERTATION DEFENSE
*Must be submitted at least two weeks before the defense date.
Name
*
First Name
Last Name
Title of Dissertation
*
Dissertation Chair
*
First Name
Last Name
Committee Member
*
First Name
Last Name
Committee Member
*
First Name
Last Name
Committee Member
*
First Name
Last Name
Date requested for Dissertation Defense
*
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Month
-
Day
Year
Date
Time requested for Dissertation Defense
*
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:
Hour
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30
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50
Minutes
AM
PM
*
I have completed all preliminary requirements for the Doctor of Philosophy (Ph.D.) degree and am now ready to defend my dissertation.
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