Jackson State University - Division of Graduate Studies

Application for Admission to Graduate Degree Candidacy:  Doctoral

Directions:  On-line directions are found in "CyberOrientation".  Click here: Doctoral Information.

Please submit three (3) copies of form (one original and two copies) to the Division of Graduate Studies.

Section 1.  To be completed by the student.  Complete the "typed" section prior to printing and obtaining the required signatures.

Name:   JSU ID No. J

Street, Apt. No.

City, State, Zip.

Home/Cell Telephone:    E-mail:   

Degree and Major:  

Expected Date of Graduation:   Year:   Semester: 

Signature of Student/Date:  ___________________________/____

Title of Dissertation:

Section 2. Committee Approval

We have read this proposal for significance, methodology, sources of data, compliance with IRB/IACUC regulations and recommend its acceptance. We agree to serve on this committee in accordance with the policies of the department/program, college, and Division of Graduate Studies. Note The  Dissertation Committee must be formed at this time.


Committee Chair/Date

Name Typed:

Committee Member/Date

Name Typed:

Committee Member/Date

Name Typed:

Committee Member/Date

Name Typed:

Committee Member/Date

Name Typed:


Committee Member/Date

Name Typed:

Section 3.  Certification and Recommendation of the Department/Program and College.
We have examined the entire graduate record of the student named above. The department/program grade point average (GPA) has been maintained on the graduate record. All requirements for degree candidacy of the department/program, school, college and the Division of Graduate Studies have been met. (Please attach a current Degree Evaluation)

We recommend that this student be admitted to candidacy for the degree indicated. (Please sign and date).


Advisor: __________________________________/______


Program Director: ___________________________________/_____


Chair: __________________________________/_____


College Dean: _________________________________/_____

Section 4.  Accepted for the Graduate Council.

Graduate Dean:  ____________________________________/_______

Effective: January 2008, supercedes Forms A and II.