CALIFORNIA STATE UNIVERSITY, LOS ANGELES
                                                                     GS-12
                                                                     (7/92)

REQUEST FOR THESIS OR PROJECT COMMITTEE AND TITLE


For: _____________________________     _____________      __________________
     Last Name          First	          SS# 	             Department


Title or topic area for the proposed thesis or project is:

____________________________________________________________________________

____________________________________________________________________________ 

____________________________________________________________________________ 

I hereby approve the following faculty to serve as the Thesis/Project
Committee for the above named student:


(*TYPE IN NAMES AND DEGREES OF COMMITTEE MEMBERS AND OBTAIN 
THEIR SIGNATURES)



___________________________________	            ________________________
Committee Chair        *NAME/DEGREE	    		     Signature



___________________________________	            ________________________
Faculty Member         *NAME/DEGREE	    		     Signature



___________________________________	            ________________________
Faculty Member         *NAME/DEGREE	    		     Signature
(as required)


___________________________________	            ________________________
Faculty Member         *NAME/DEGREE	    		     Signature
(as required)

************************************************************************


___________________________________	            ________________________
Department Chairperson                                         Date


Committee membership is certified by:


___________________________________	            ________________________
Associate Dean	                                               Date