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Summary: 12/05/2011
CHANGE OF GRADUATE SUPERVISOR(S) FORM
Please submit this form to the head (or designate) of your academic unit.
Name: _____________________________________ Student Number: _________________________
Legal Last Name Legal First Name
Current Address: ____________________________________________________________________
Current E-mail Address: ______________________________________________________________
Degree: ____________________________________ Major: __________________________________
Reason(s) for Change (please attach additional documentation if required):
Student's Signature: ___________________________________________ Date: ___________________
Previous Supervisor's Name: _________________________________
Previous Supervisor's Signature:______________________________ Date: ___________________
Previous Co-Supervisor's Name: ______________________________
Previous Co-Supervisor's Signature_____________________________ Date: ___________________
New Supervisor's Name: ____________________________________
New Supervisor's Signature:__________________________________ Date: ___________________
Department Head Only: (include pertinent comments as may apply). Please Note:
a) The new supervisor should have an accreditation level consistent with the student's program of studies
b) The department and FGSR have no responsibility to agree to a change in supervisory arrangements if
they cannot reasonably be accommodated. (In this regard, the department should consult with FGSR and
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