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Application for change within thesis

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Application for change within thesis

PhD / Doctor of Philosophy (Q 794 440 202)

Clinical PhD / Doctor of Philosophy (Q 794 445 202)

Please complete this form exclusivly computer based and tick where appropriate!

Department of International Relations - PhD School

Fritz-Pregl-Straße 3, 4.Stock 6020 Innsbruck, Austria Tel. +43 512 9003 - 70050

PhD-Studien@i-med.ac.at, www.i-med.ac.at

Applicant

Academic degree, surname:

...

First name:

...

Registration number:

...

Address:

...

...

Phone number:

...

E-Mail:

...

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(2)

Changes

change of

TITLE SUPERVISOR/MEMBER OF COMMITTEE PROGRAMME

Current title of thesis:

...

...

New title of thesis:

...

...

Title

Supervisor/Member of committee

Name of current supervisor / member of committee:

...

...

Name of the new supervisor / member of committee:

...

...

Programme

Current programme:

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New programme:

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Student‘s reasons for changes:

...

...

... ...

Date Student‘s signature

Reasons

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Changes of research topic, supervisor, doctoral programme represent major changes in the doctoral studies that require prior consultation and approval by the thesis commit- tee. A corresponding statement signed by all committee members has to be supplied together with this application.

signed statement of thesis committee is attached Thesis committee members remain the same

YES

NO, new committee members:

Thesis committee

1st Member:

...

Department/Clinic:

...

2nd Member:

...

Department/Clinic:

...

change of title/supervisor/programme

accepted YES NO

... ...

Changes

Agreement of PhD programme coordinator

Date Signature of PhD programme coordinator (name:)

Agreement of Vice Rector for Teaching and Study Matters

... ...

Date Vice Rector for Teaching and Study Matters

ao. Univ.-Prof. Dr. med. univ. Wolfgang Prodinger, MME (Bern)

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NO change of title/supervisor/programme

accepted YES

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