Chicago State University 0ffice of Graduate and Professional Studies
Thesis/Dissertation Committee Notification Form	
When committee members are identified for a thesis or dissertation committee, the thesis/dissertation advisor should submit the names of the committee members to the Associate Provost, Graduate and Professional Studies.  Students who are completing a thesis or dissertation and their advisors will be informed of events and workshops designed to assist graduate and professional students at Chicago State University.   
Student Name:___________________________________________   CSU ID: ___________________
CSU email address: _________________________________________
Check one:           □   Master’s Degree Thesis		□  Dissertation
Degree (circle):   MA    MFA    MS    MSEd   MPH    MSN   EdD	Program: _______________________
In which term will first thesis/dissertation course be taken?  Fall     Spring    Summer       Year ______
Committee Membership (please print)			Signature			Date

Chair/Advisor ___________________________	___________________________	________

Member         ___________________________	___________________________	________

Member         ___________________________	___________________________	________

Member         ___________________________	___________________________	________

Member         ___________________________	___________________________	________

Member         ___________________________	___________________________	________ 

Dept Chair      ___________________________	___________________________	________

Scan/email form to graduateprograms@csu.edu or send to ADM 200 after dept. chair signature is obtained.