School of Nursing
MSN Program
Thesis/Project Committee Consent Form
The student noted below has
requested that I serve on her/his Thesis/Project Committee in the capacity of
Member or Chairperson to assist in the preparation of the thesis/project. It is understood that this will involve
meeting with the Committee and providing assistance to the student while
completing the thesis/project. In the event the need arises to withdraw my participation,
the Chairperson of the committee, Coordinator of the MSN Program, Chair of the
Department of Nursing, and the student will be notified in writing one month in
advance of discontinuation of the committee.
Proposed Title of
Thesis/Project:
Student:
Date:
____________________
Signature of Chairperson
____________________
Signature of Member
____________________
Signature of Member
____________________
Student