Form GS-12

CALIFORNIA STATE UNIVERSITY, LOS ANGELES
GS-12 (7/92)
REQUEST FOR THESIS OR PROJECT COMMITTEE AND TITLE
For: _____________________________ _____________ __________________ Last Name First SS# Department Title or topic area for the proposed thesis or project is: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ I hereby approve the following faculty to serve as the Thesis/Project Committee for the above named student: (*TYPE IN NAMES AND DEGREES OF COMMITTEE MEMBERS AND OBTAIN THEIR SIGNATURES) ___________________________________ ________________________ Committee Chair *NAME/DEGREE Signature ___________________________________ ________________________ Faculty Member *NAME/DEGREE Signature ___________________________________ ________________________ Faculty Member *NAME/DEGREE Signature (as required) ___________________________________ ________________________ Faculty Member *NAME/DEGREE Signature (as required) ************************************************************************ ___________________________________ ________________________ Department Chairperson Date Committee membership is certified by: ___________________________________ ________________________ Associate Dean Date