College of Nursing - Dissertation Guide

15 COLLEGE OF NURSING DISSERTATION COMMITTEE MEMBERSHIP FORM We, the undersigned, agree to serve as members of the Dissertation Committee of: ____________________________________________________is developing a proposal for a dissertation tentatively titled: _____________________________________________________________________________ (Agreement to be a member of the Dissertation Committee does not imply acceptance of the proposal.) ______________________________________________________________________/___/___ Signed, Chairperson, Dissertation Committee Printed Name Date ______________________________________________________________________/___/___ Signed, 2nd Committee Member Printed Name Date ______________________________________________________________________/___/___ Signed, 3rd Committee Member Printed Name Date ______________________________________________________________________/___/___ Signed, PhD Program Director Printed Name Date