REQUEST FOR CHANGE IN DISSERTATION/THESIS COMMITTEE FORM Date: Z Number: Student Name: Anticipated Graduation Term: Major: Degree: Please note: Request for changes in dissertation or thesis committees must be initiated and approved at least one semester prior to applying for graduation Requested Changes to Current Committee Please note the following: a Members to be removed, added, or their roles modified must sign to indicate agreement b Under "committee role", make a selection for new members being added (chair, co-chair or member) and current members whose role is being modified (member to chair or co-chair, co-chair to member, etc) c The full Graduate Faculty Membership list and policy is available at http://www.fau.edu/graduate/faculty-and-staff/graduate-faculty.php Action (Select for each if adding, removing or modifying) Committee Role (Print Name) (Select if member, chair, or co-chair) (Signature) Changes to Dissertation/Thesis Commitee approved by Department, College and the Graduate College: Student (Signature) Date Supervisory Committee Chair or Designee (Signature) Date Department Chair or Designee (Signature ) Date College Dean or Designee (Signature) Date Dean of the Graduate College or Designee (Signature) Date *Please submit completed form to graduatesupport@fau.edu for Graduate College final approval/signature A copy of the approved form will be emailed to the student and college designee(s) and kept on file in the Graduate College Updated February 2021