APPLICATION FOR WRITTEN PRELIMINARY EXAMINATION ITEM INFORMATION Comments/Action 1 STUDENT LAST NAME: PRINT: 1.1 STUDENT FIRST NAME: 1.2 STUDENT IDENTIFICATION: 991 --- --- 1.3 STUDENT SIGNATURE & DATE: 2 HOME INSTITUTION: 2.1 SPECIALIZATION: 2.2 PROGRAM PRINT NAME: PLANNING COMMITTEE CHAIR: 2.3 PROGRAM PRINT NAME PLANNING COMMITTEE MEMBER: 2.4 PROGRAM NAME PLANNING COMMITTEE MEMBER: 3.0 RESIDENCY 9 HOUR 18 HOUR INFORMATION: TERM CALENDAR YR 3.1 COT710 TERM COMPLETED: GRADE(S): COT711 or COT709 3.2 RESEARCH TOOL 1A COT702 TERM COMPLETED: GRADE: – ADVANCED RESEARCH METHODS 3.3 RESEARCH TOOL 1B ITEC6050 TERM COMPLETED: GRADE: – ADVANCED RESEARCH METHODS 3.4 RESEARCH TOOL II COT 703 TERM COMPLETED: GRADE: – ADVANCED RESEARCH METHODS 4.0 PROPOSED LOCATION AND LOCATION: DATE RANGE: DATE OF EXAMINATION: 4.1 PROCTOR EMAIL: CONTACT INFORMATION: 4.2 PROCTOR EVALUATION INFORMATION: 4.3 PROCTOR APPROVED: CIRCLE DATE VERIFIED BY PROGRAM Y N 4.4 REQUEST APPROVED CIRCLE BELOW CHAIR SIGNATURE & DATE: PPC CHAIR: Y N 4.5 REQUEST APPROVED CIRCLE BELOW COORDINATOR SIGNATURE & PROGRAM COODINATOR: Y N DATE: 4.6 REQUEST APPROVED CIRCLE BELOW DIRECTOR SIGNATURE & DATE PROGRAM DIRECTOR: Y N
APPLICATION FOR WRITTEN PRELIMINARY EXAMINATION ITEM INFORMATION Comments/Action 1 STUDENT LAST NAME: PRINT: 1.1 STUDENT FIRST NAME: 1.2 STUDENT IDENTIFICATION: 991 --- --- 1.3 STUDENT SIGNATURE & DATE: 2 HOME INSTITUTION: 2.1 SPECIALIZATION: 2.2 PROGRAM PLANNING COMMITTEE CHAIR: PRINT NAME: 2.3 PROGRAM PLANNING COMMITTEE MEMBER: PRINT NAME 2.4 PROGRAM PLANNING COMMITTEE MEMBER: NAME 3.0 RESIDENCY INFORMATION: 9 HOUR TERM 18 HOUR CALENDAR YR 3.1 COT710 COT711 or COT709 TERM COMPLETED: GRADE(S): 3.2 RESEARCH TOOL 1A – COT702 ADVANCED RESEARCH METHODS TERM COMPLETED: GRADE: 3.3 RESEARCH TOOL 1B – ITEC6050 ADVANCED RESEARCH METHODS TERM COMPLETED: GRADE: 3.4 RESEARCH TOOL II – COT 703 ADVANCED RESEARCH METHODS TERM COMPLETED: GRADE: 4.0 PROPOSED LOCATION AND DATE OF EXAMINATION: LOCATION: DATE RANGE: 4.1 PROCTOR CONTACT INFORMATION: EMAIL: 4.2 PROCTOR EVALUATION INFORMATION: 4.3 PROCTOR APPROVED: CIRCLE Y N DATE VERIFIED BY PROGRAM 4.4 REQUEST APPROVED PPC CHAIR: CIRCLE BELOW Y N CHAIR SIGNATURE & DATE: 4.5 REQUEST APPROVED PROGRAM COODINATOR: CIRCLE BELOW Y N COORDINATOR SIGNATURE & DATE: 4.6 REQUEST APPROVED PROGRAM DIRECTOR: CIRCLE BELOW Y N DIRECTOR SIGNATURE & DATE
WRITTEN.PRELIM.APPLICATION.docx