Checklist to Submit Electronic Thesis/Dissertation In order to verify completion of graduation requirements, the department will complete the Checklist to Submit Electronic Thesis/Dissertation form. This form must be completed by a representative of the graduating department. "*" indicates required fields Thesis/Dissertation Title:*HiddenPlease list the student authors' names as they appear on the thesis/dissertation title page.Student Names*Please list the student authors' names as they appear on the thesis/dissertation title page. First Middle Last Add Additional Name(s)?Include only the students who have successfully defended their thesis. Yes No Second Name First Middle Last Third Name First Middle Last Fourth Name First Middle Last Department:* Thesis/Dissertation Advisor:* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Middle Last HiddenAdd Committe Member(s)? Yes No HiddenCommittee Member: Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Middle Last HiddenCommittee Member: Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Middle Last HiddenCommittee Member: Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Middle Last Electronic Thesis/Dissertation ChecklistCheck all that apply. Leave blank if not applicable.* Received final copy of thesis/dissertation. Received Certification of Committee Approval. Thesis/dissertation is ready to submit. HiddenThesis/Dissertation Signature Page Electronic copy of the thesis/dissertation (pdf) includes the signed signature page as stipulated by Brenau University's thesis requirements and illustrated in the thesis guide. Comments:Form submitted by:* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Email* 6-Digit Brenau ID for authentication* Date* MM slash DD slash YYYY CAPTCHAEmailThis field is for validation purposes and should be left unchanged.