Preliminary Warrant Request Form to Become a Dissertator

The request form should be filled out at least 3 weeks prior to the oral exam. Please fill in all known committee member names. If you do not know who will be on your committee, fill in just your advisor’s name.

Please check your grades, if there is a temporary grade (NR, I, P, or Q), contact the professor who taught the course to change the grade. The Graduate School will not issue a warrant if you have temporary grades.

If you are a student who transferred into the Chemistry PhD Program at UW, you will need to include information about your coursework from your previous graduate institution. This is so the Graduate School can verify you have met the Minimum Graduate Degree Credit and Coursework Requirements. You will need to enter information for up to five graduate courses that you took while at your previous graduate institution. You will need to include the following information for each course:

Institution
Course Name
Course Number
Academic Term
Credits

The Graduate Program Office will request the warrant from the Graduate School and email you when the request has been submitted. When the Graduate School approves the request, we will send an email to notify you that the request was approved and your warrant and instructions are in your mailbox.

Name*
First Last
Proposed date of prelim exam*
MM slash DD slash YYYY
Date of completion of coursework*
MM slash DD slash YYYY
External doctoral minor program name (if applicable)

(Note: Doctoral students in Chemistry are not required to complete a doctoral minor or graduate/professional certificate as breadth is built into the major requirements.)
Committee member name*
First Last
Committee member name
First Last
Committee member name
First Last
Committee member name
First Last
Committee member name
First Last
Prior Graduate Coursework
(List your prior graduate coursework if you transferred to UW - Madison from another graduate institution. Please include the institution name, course name, course number, term, and number of credits. You should list up to five courses.)
Phone
This field is for validation purposes and should be left unchanged.