KENT STATE UNIVERSITY
REPORT OF FINAL EXAMINATION
AFTER VERIFICATION OF THIS FORM BY THE COLLEGE OR INDEPENDENT SCHOOL, A COPY WILL BE
RETURNED TO THE DEPARTMENT.
Student Number___________________
1. Name of candidate ____________________________________________________________________
LAST FIRST MIDDLE
Address ____________________________________________________________________________
NUMBER & STREET CITY STATE ZIP
2. Degree for which examination is given____________________________________________________
3. Department__________________________________________________________________________
Special area of concentration (if any)______________________________________________________
4. Exact title of thesis or dissertation________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
5. If master’s degree candidate elected an option not requiring a thesis, indicate which one and briefly describe work done in lieu of thesis_______________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
6. Signature of examining committee:
Name (typed or printed) Signature Pass Fail*
(Use check mark)
_________________________ ____ ____
COMMITTEE CHAIR
_________________________ ____ ____
_________________________ ____ ____
_________________________ ____ ____
_________________________ ____ ____
_________________________ ____ ____
OUTSIDE DISCIPLINE PERSON
_________________________ ____ ____
GRADUATE FACULTY REPRESENTATIVE
FINAL RESULT: Pass Fail
___________________________________________________________
MODERATOR (doctoral examination only – does not vote)
*Attach comments or specified conditions if student fails.
_______________________________________________________________________________
CHAIR, DIRECTOR OR DEAN