Republic of the Philippines

POLYTECHNIC UNIVERSITY OF THE PHILIPPINES

Office of the Vice President for Academic Affairs
TDW Form No. 11

THESIS/DISSERTATION PANEL ON ORAL DEFENSE APPOINTMENT AND ACCEPTANCE FORM

Name of Student/Candidate _________________________________ Program __________________

School Year & Semester Started in the Program ___________________________________________

Date of Passing the Comprehensive Examination __________________________________________

Thesis/Dissertation Title: ______________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

Adviser: ___________________________________________________________________________

Final Defense Name Signature (Signifying Date of

Panel Acceptance of Signing
Appointment)
Chair

Members

(3 for a Thesis /
4 for a Dissertation)

Recommending Approval: Approved by:

___________________________________ _____________________________
Program Chair Dean/Director