FORM PGR11 APPOINTMENT OF EXAMINERS
PLEASE NOTE
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This form must be typed. Handwritten forms will not be accepted.
Double clicking on the check boxes enables you to change them from not-checked to checked.
Normally, examiners are chosen on the basis of content, methodology and experience
Normally 3 examiners are appointed for doctoral examinations and 2 for master’s
All appointment forms should include a reserve examiner
Student ID No
Name
Is the Student an AUT Staff Member?
Yes
No
Faculty
School/Dept
Programme
Expected Date of
Submission
Thesis
Dissertation
Points Value
Pathway 1
Pathway 2
Pathway 3
Title
Has an embargo been approved for this research?
Yes
No
Approved for
months
The following persons are recommended for appointment as examiners for the above student. Details on the nominated
examiners are attached which briefly outline to the suitability of the examiners and their experience in the examination of
theses/dissertations.
Note:
Honoraria are not normally paid to examiners in the wider university community
If the student is an AUT staff member ALL examiners should normally be external
All faculty approvals must be signed before this form is sent to the UPC
Examiners should not have had any working relationship with the candidate
FIRST EXAMINER
Name
Willingness to Accept
Yes
No
Qualifications (Qual & Uni)
Examined Before
Yes
No
Doct
Master’s
Yes
No
Number of Previous
Doctoral Examinations
Institution (Current Employer)
Honorarium
Office Ph
Honorarium Amount
E-Mail Address
Mbl Number
Full Physical Address or
AUT internal mail-code
(no PO Box numbers)
Justification
(Please attached current CV which
should include examination experience)
SECOND EXAMINER
Name
Willingness to Accept
Yes
No
Qualifications (Qual & Uni)
Examined Before
Yes
No
PGR11 – Appointment of Examiners
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Doct
Master’s
Yes
No
Number of Previous
Doctoral Examinations
Institution (Current Employer)
Honorarium
Office Ph
Honorarium Amount
E-Mail Address
Mbl Number
Full Physical Address or
AUT internal mail-code
(no PO Box numbers)
Justification
(Please attached current CV which
should include examination experience)
THIRD EXAMINER
Name
Willingness to Accept
Yes
No
Qualifications (Qual & Uni)
Examined Before
Yes
No
Doct
Master’s
Yes
No
Number of Previous
Doctoral Examinations
Institution (Current Employer)
Honorarium
Office Ph
Honorarium Amount
E-Mail Address
Mbl Number
Full Physical Address or
AUT internal mail-code
(no PO Box numbers)
Justification
(Please attached current CV which
should include examination experience)
RESERVE EXAMINER(A RESERVE EXAMINER SHOULD BE APPOINTED FOR ALL EXAMINATIONS)
Name
Willingness to Accept
Yes
No
Qualifications (Qual & Uni)
Examined Before
Yes
No
Doct
Master’s
Yes
No
Number of Previous
Doctoral Examinations
Institution (Current Employer)
Honorarium
Office Ph
Honorarium Amount
E-Mail Address
Mbl Number
Full Physical Address or
AUT internal mail-code
(no PO Box numbers)
Justification
(Please attached current CV which
should include examination experience)
PGR11 – Appointment of Examiners
V1.0
Update Nov 12
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CREATIVE WORK – EXHIBITION / PERFORMANCE DETAILS
If applicable please provide below details of your exhibition/performance etc
Exhibition/Performance Name (if applicable)
Date(s)
Time(s)
Venue
Attach a map to this form if appropriate
Weighting component (%) of the creative work in terms of the thesis as a whole
SCHOOL AND FACULTY APPROVALS
Primary Supervisor
Signature
Secondary Supervisor
Signature
Additional Supervisor
Signature
Date
Mentor Supervisor
Signature
Date
Assoc Dean
Signature
Faculty
Approval Date
PGR11 – Appointment of Examiners
V1.0
Date
Date
Update Nov 12
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