Department of Computer Science
www.cs.uiuc.edu
Request for Appointment of Preliminary/Final Exam Committee
 Prelim Exam  Final Exam
Please place an “X” by the exam you are completing:
STUDENT INFORMATION
TERM QUALIFYING EXAM PASSED: Spring Fall 20___
Name
UIN
Current Local Address
Graduate students who entered Illinois Fall 2001 or later whose native language is not English (regardless of US citizenship) are
required to have passed (50/60) the TSE or SPEAK exam. Please indicate the test you took and when.
TSE (MM/YY)
SPEAK (MM/YY)
Area of Research (Please place an “X” next to one area.)
Algorithms & Theory
Computer & Education
Artificial Intelligence
Cultural Computing
Systems & Networking
Programming Languages, Formal
Systems & Software Engineering
Arch, Parallel Computing & Systems
Database & Information Systems
Scientific Computing
Bioinformatics & Computational Bio
Graphics, Visualization & HCI
Thesis Title
Date of Exam
Location/Time
EXAM COMMITTEE: Minimum of four voting members required where at least 3 are members of the Illinois Graduate faculty,
at least two are tenured, at least three members are CS extended faculty (regular, affiliate, adjunct, research or emeritus assistant or
associate professors), two of whom must be regular full-time CS faculty, and one committee member must be from outside Illinois if
the Ph.D. Qualifying Exam was passed in Spring 2006 or later (this is highly recommended for all students).
Chair
Department
Director of Dissertation*
Department
*May or may not be the same as Chair
Committee Member
Department
Committee Member
Department
Committee Member
Department
Committee Member
Department
External non-UIUC Member
Institution/
Department
Graduate College requires you to be registered in the term in which you defend. Are you registered?
Yes 
Have you turned in your thesis proposal (for Prelim) or thesis (Defense) 3 weeks prior to the exam?

Yes
No
No
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