Request For Exemption Form
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1University of California, Berkeley ∙ Graduate Division
REQUEST FOR EXCEPTION FORM
FOR NON-ACADEMIC SENATE MEMBER TO SERVE ON HIGHER DEGREE COMMITTEE
_________________________________________________
__________________
Student Last Name
First
Middle
SID
____________________________________
Major
Committee type:
Qualifying Exam
Dissertation
Master’s
Proposed committee member name: _____________________________
Email Address (required): ______________________________________
Does the proposed committee member
:
(you must check all)
Hold a degree equivalent to that which is being examined/earned?
Have published work listed on his or her CV within the last 3 years?
Have special and necessary expertise that cannot be duplicated on campus?
(Non-UCB Professors) agree to serve on the committee without compensation (lecturers must be
compensated per their union contract)
Proposed committee:
Name
Appointment
Position
(e.g. Professor, Adjunct, Lecturer, Emeritus, etc.)
(e.g. chair, co-chair, inside)
_________________________ _____________________________
__________________
_________________________ _____________________________
__________________
_________________________ _____________________________
__________________
_________________________ _____________________________
__________________
_________________________ _____________________________
__________________
_________________________ _____________________________
__________________
NOTE: non-senate members may NOT serve as sole chair, the only inside member, or as outside
member.
Signature of Head Graduate Advisor
Date
[Please attach CV and submit to: Graduate Degrees, 318 Sproul Hall, MC 5900]
Rev.2/7/12
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