Thesis/dissertation Submission Form Page 2
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2University of Oregon Graduate School
THESIS/DISSERTATION DOCUMENT APPROVAL
Page 2 of 2
This form serves as official certification that the electronic thesis or dissertation uploaded is the final version approved by the committee listed
below. Please submit this form along with your Thesis/Dissertation Submission Form, after uploading your document to the UMI ETD Site.
Ph.D.
D.Ed.
D.M.A.
Master of __________________________________________
Student ID Number: ______________________________________
Term/year of graduation: __________________
Student Name of Record (as it appears in DuckWeb):
____________________________________
______________________________________ __________________
Last (Family) Name
First Name
Initial
Major (as listed in DuckWeb)
Title of Thesis or Dissertation (as listed on Abstract):
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Committee Membership:
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
Committee
Signatures : I have accepted and approved the final version of this thesis or dissertation on behalf of the committee.
Chair (or co-chair): ________________________________
_______________________________________
______________
Printed Name
Signature
Date
Co-Chair (if applicable): ____________________________
_______________________________________
______________
Printed Name
Signature
Date
Advisor (if applicable): ____________________________
_______________________________________
______________
Printed Name
Signature
Date
STUDENT: I certify that the thesis or dissertation that I have submitted to the Graduate School is the final version
approved by my committee and agree that no changes will be made other than those required by the Graduate School.
Student Signature: _______________________________________________________
Date: ______________________
[OFFICIAL USE ONLY]
Graduate School Editor Approval: ___________________________________________________ Date: ____________________
Graduate School Dean Approval: ___________________________________________________ Date: ____________________
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