Program in Neuroscience
THESIS DECLARATION FORM
(Thesis Topic and Committee Declaration Form)
Turn in to Joanna Shipley in MBH 375 no later than the last day of
classes, in the final semester of NSCI 0500 or 0700, prior to taking NSCI 0701.
This form is intended to verify that you have reached an agreement on a potential thesis topic with a
thesis advisor, that your topic is appropriate for a Neuroscience thesis (i.e., it advances understanding of
the operation of the nervous system and the mind), and that at least two members of the Neuroscience
faculty are on your thesis committee.
Student Name:
Grad Year:
Proposed Thesis Topic:
Term (FWS):
Year:
Semester(s) of NSCI 0500 or 0700:
Semester of NSCI 0701:
Thesis Committee Members*:
1)
(Thesis Advisor)
2)
(Reader)
3)
(Reader)
We have agreed to serve on the thesis committee of the above-named candidate
Thesis Committee Member Signatures:
1)
2)
3)
Program Director signature
Date
* At least two of your committee members must be Neuroscience faculty, and one of those must be a primary
Neuroscience faculty.
Rev. 9/2014