Technology and Society Emphasis Completion Form
Name
Department
E-mail
PERM
Please list the courses you have completed to fulfill the T&S Emphasis requirements. Note: Any courses that are NOT currently listed at http://cits.ucsb.edu/requirements
will require an approved petition to count toward the Emphasis (see website for Course Petition Form), even if courses were listed on prior CITS websites. A grade of B or
better is required in each course. Please attach a transcript (GOLD printout is acceptable).
Title
Instructor
Qtr/Yr
Petition*
Grade
Area 2:
Society &
Behavior
Area 1:
Culture &
History
Course #
Technology & Society Gateway Seminar
* Check the box if this class is NOT currently listed on the T&S Emphasis Requirements page and you have petitioned or will petition for it to count toward the Emphasis.
Dissertation committee members:
Chair(s):
T&S Faculty (non-major dept):
Other committee
members:
Dissertation title:
Abstract (attach additional page(s) if necessary):
This page represents the student's finalized committee and defended dissertation topic.
Student
signature:
T&S Director
signature
Committee
Chair signature:
Date: