Republic of the Philippines

POLYTECHNIC UNIVERSITY OF THE PHILIPPINES

Office of the Vice President for Academic Affairs
TDW Form No. 04

THESIS/DISSERTATION ADVISER APPOINTMENT AND ACKNOWLEDGEMENT FORM

_________________________
(Date)

_________________________
(Name of Faculty)

Sir/Madam:

You have been favorably recommended by the Program Chairperson to Supervise the following
thesis/ dissertation paper:

Thesis/Dissertation Title:
Name of Proponent:
Program:

Kindly confirm your acceptance of this endorsement. Thank you very much.

Truly yours,

__________________________
Dean
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I hereby read the attached thesis/dissertation manuscript and I accept my appointment as

Thesis/Dissertation Adviser. I commit to supervise the Student throughout the thesis/dissertation writing
process and provide the necessary guidance by being available for periodic meetings and draft/performance
reviews of his/her written work.

I further certify that this assignment is within the allowable number of advisees based on the Graduate
School Guidelines on Thesis/Dissertation Writing.

Thesis/Dissertation Title:
Name of Proponent:
Program:

________________________________________________
(Signature over Printed Name of Thesis/Dissertation Adviser)

Date: ___________________________________________