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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
DISSERTATION COMMITTEE FORM
Student Name: Program Name:
Academic Program Number:
Revise Committee
Create Committee
Please refer to the Guidelines for Dissertation Committee Service.
When revising a Dissertation Committee, list all other members of the committee as well as the revision(s).
9.10
Action Requested: If defense date is in less than 6 months, give approximate date:
(YY)(DD)(MM)
Proposed Committee Membership (PLEASE NOTE: In certain circumstances, additional documentation must be submitted with this
form. Please see the Guidelines for Dissertation Committee Service).
(YY)
(YY)(DD)
(DD)(MM)
(MM)
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