Graduate Student Exam Request

Ph.D. Qualifying

• Please keep in mind when filling out this form that you are creating a posting on the ECE website which is fully viewable on the internet. Maintain proper spelling, punctuation, and capitalization.
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First Name:

Middle Name:

Last Name:
CSU ID:
Email:
Telephone:

Date of Defense (Month): Month... JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Date of Defense (Day): Day... 01020304050607080910111213141516171819202122232425262728293031 Date of Defense (Year): Year... 2021 2022
Start Time (Hour): Hour... 010203040506070809101112 Start Time (Minute): Minute... 000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 Start Time (A.M. or P.M.): AM or PM ... AM PM
End Time (Hour): Hour... 010203040506070809101112 End Time (Minute): Minute... 000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 End Time (A.M. or P.M.): AM or PM ... AM PM

Location:
(Complete only if you have already reserved space - otherwise indicate N/A)

Adviser:
Adviser email:
Co-Adviser (if applicable):
Outside Member, Dept:
Committee Member 3, Dept:
Additional Committee Members:

Publication 1 Title:
URL: (provide a link to the document)
Publication 2 Title:
URL: (provide a link to the document)

List Courses From Your GS6 or Courses You Have Completed (ECExxx MATHxxx etc.)

Class 1: Class 2: Class 3: Class 4: Class 5: Class 6: Class 7: Class 8:

Student Publications: