Doctoral Committee Approval Form
Use this form to request and record doctoral committee approval for a doctoral dissertation or thesis process.
Student and Program Information
Doctoral Candidate Name
*
First Name
Middle Name
Last Name
University or Institution Name
*
Department or Program
*
Student ID
Degree Type / Track
*
Please Select
PhD
EdD
DBA
Other
Dissertation or Thesis Title
*
Dissertation Stage / Status
*
Please Select
Proposal
Data Collection
Analysis
Writing
Ready for Defense
Scheduled for Defense
Revisions Required
Completed
Other
Proposed Defense / Approval Date Range
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Committee Composition
Committee Chair Name
*
First Name
Middle Name
Last Name
Primary Advisor / Supervisor Name
*
First Name
Middle Name
Last Name
Co-Advisor Name
First Name
Middle Name
Last Name
Committee Members
Committee Member Roles / Notes
Approval and Review Details
Committee Approval Decision
*
Approved
Approved with Revisions
Deferred
Not Approved
Dissertation Readiness Rating
*
Not Ready
1
2
3
4
5
6
7
8
9
Fully Ready
10
1 is Not Ready, 10 is Fully Ready
Review Comments
Required Revisions
Conditions for Approval
Evaluation Criteria
Rows
Poor
Fair
Good
Excellent
Research Quality
1
2
3
4
Methodology
5
6
7
8
Writing Quality
9
10
11
12
Preparedness
13
14
15
16
Submission and Recordkeeping
Submission Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reviewer / Approver Name or Role
*
Internal Tracking / Reference Number
Administrative Notes
Submit Approval
Should be Empty: