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									                                                                                                                            06/12

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                             Program of Study for Doctoral Degree*
Name                                                                       A-Number


E-Mail                                                        Department


Degree Sought                     Program/Major

Specialization

(Only specializations approved by the Utah State Board of Regents will appear on the official transcript)
    Check One       I hold only a bachelor's degree               I hold both a bachelor's and a master's

Term                            Year

                                                                                                                           Check
Title                                           Subject           Course          Grade       Credits       Remarks      (SGS only)




Term                            Year

                                                                                                                           Check
                                                                                                                         (SGS only)
Title                                           Subject           Course          Grade       Credits       Remarks




Term                            Year

                                                                                                                           Check
                                                                                                                         (SGS only)
Title                                           Subject           Course          Grade       Credits       Remarks
        Program of Study for Doctoral Degree
                          continued

Name                     A-Number



Term    Year

                                                                    Check
Title          Subject   Course       Grade   Credits   Remarks   (SGS only)




Term    Year

                                                                    Check
Title          Subject   Course       Grade   Credits   Remarks   (SGS only)




Term    Year

                                                                     Check
Title          Subject   Course       Grade   Credits   Remarks    (SGS only)




Term    Year

                                                                     Check
Title          Subject   Course       Grade   Credits   Remarks    (SGS only)
        Program of Study for Doctoral Degree
                             continued
Name                       A-Number



Term    Year

                                                                         Check
Title          Subject     Course          Grade   Credits   Remarks   (SGS only)




Term    Year

                                                                         Check
Title          Subject     Course          Grade   Credits   Remarks   (SGS only)




Term    Year

                                                                          Check
Title          Subject     Course          Grade   Credits   Remarks    (SGS only)




Term    Year

                                                                         Check
Title          Subject     Course          Grade   Credits   Remarks   (SGS only)




                         Credit Subtotal
                               Program of Study for Doctoral Degree
                                                                  continued
Transfer Credits

   Semester Hours        Quarter Hours
                                                                                                                                 Check
Institution                           Semester/Qtr      Year              Subject          Course           Credits      Grade (SGS only)




Title of Dissertation


Prerequisites and other requirements of the programs, not taken for graduate credit




Approval Signatures


Major Professor                                          Date            Department Head                                        Date


Supervisory Committee


                                                         Date                                                                   Date


                                                         Date                                                                   Date


Student Signature                                        Date

                                                                         Signatures in ink indicate that the proposed program of study and
                                                                         thesis/report will fulfill requirements of this degree. Amendments
                                                                         can be made with an e-mail from the major professor to Joan Rudd
School of Graduate Studies Approval
                                                                         (joan.rudd@usu.edu) and carbon copies (CCs) must be sent to all
                                                                         committee members.


School of Graduate Studies                               Date


*Submission Instructions
When you have completed this form, print a copy for review by your Supervisory Committee. After you have obtained the necessary
signatures, please return the form to the School of Graduate Studies (Old Main Room 164: UMC 0900)




         Print Form

								
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