Adult Development & Aging Doctoral Program
A Joint Program of
Cleveland State University & The University of Akron
Petition to Defer Dissertation Defense
Name
Procedure
The dissertation defense is due by April 1 of the fifth year. In the event that a student needs an
extension, he or she must petition the faculty. This completed form is due to the Program Chair by
March 1 of the fifth year.
Reason for Requesting Extension on Master’s Thesis Defense Deadline
Please describe the reason for requesting an extension on this deadline in the space below.
Revised Date for Dissertation Defense
I will defend my dissertation on
(Date)
Signatures
Student:
Print Name:
_________________________________________
Date: ______________
Advisor:
Print Name:
________________________________________
Date: ______________
UA Committee Member: ________________________________
Print Name:
Date: ______________
CSU Committee Member: _______________________________
Print Name:
Date: ______________
Outside Committee Member: ___________________________
Print Name:
Date: ______________
Committee Member____________________________________
Print Name:
Date: ______________
Program Chair: ________________________________________
Print Name:
Date: ______________