Name: NU ID #:

Address: City/State: Zip:

Department/School: Degree Sought:

Adviser's Signature: _______________________________________________

Committee Members: A minimum of 3 members is required - at least two from the major department/school and one from another department/school. All Supervisory Committee members, except for ex-officios, must be members of the Graduate Faculty at the University of Nebraska. Please type or print names.

                 Names                                  Department/School

  
Ex-officio (optional)

Recommended by: _________________________________ Date: ______________                               Graduate Program Committee, Chair

I agree to serve on the supervisory committee for this student who is working on his/her Master's or Ed.S. degree. (Please sign your name).

Chairperson of Supervisory Committee

____________________________________
____________________________________
____________________________________
Ex-Officio (optional)

____________________________________

Approved by:___________________________________ Date: ______________

                               ( Dean for Graduate Studies)

Send to the Office of Graduate Studies, EAB 203, at least one semester before graduation.

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