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Summary: STUDENT SERVICES: ACADEMIC RECORDS & DISSERTATIONS
915 E. Washington Street 0120 Rackham Building Ann Arbor, MI 48109-1070
734-763-0171 Fax: 734-936-1809
E-mail: oard.questions@umich.edu www.rackham.umich.edu
NOMINATION FOR SPECIAL MEMBERSHIP ON DISSERTATION COMMITTEE FORM
Student Name: Program Name:
Student U-M ID:
NOMINATION FOR SPECIAL ASSIGNMENT ON THE DISSERTATION COMMITTEE
University faculty and staff who are not "Graduate Faculty" (as defined in the Guidelines for Dissertation Committee Service) and
qualified people from outside the University of Michigan who may or may not hold academic appointments and whose service on
the Dissertation Committee would contribute significantly may be nominated for special membership by submitting:
1. this completed form with the appropriate signatures and explanation of the nominees expertise in the dissertation topic
2. a vita or resume of the nominee
3. the Dissertation Committee form
(YY)(DD)(MM)
Date:
Rackham Approval Signature/Name Printed
Dissertation Committee Chair Signature/Name Printed (as appropriate)
Date:
(MM) (DD) (YY)
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