NOMINATION OF THE DISSERTATION DOCTORAL COMMITTEE FOR THE DEGREE OF DOCTOR OF PHILIOSPHY IN: Public Health - Epidemiology PU75

Appendix A

Office of Graduate Studies University of California, San Diego Graduate and Research Affairs San Diego State University La Jolla, California 92093 San Diego, California 92182 Joint Doctoral Program NOMINATION OF THE DISSERTATION DOCTORAL COMMITTEE FOR THE DEGREE OF DOCTOR OF PHILIOSPHY IN: Public Health - Epidemiology PU75 Name Last First Middle RED ID# UCSD PID # Address Number and Street City State Zip Code Telephone To: / Dean, SDSU Graduate and Research Affairs In the opinion of the Department/Group of JDP PUBLIC HEALTH at our respective institutions, the student named is ready to proceed to the Qualifying Examination(s) for the degree of Doctor of Philosophy. The proposed title of the dissertation is The following persons, who have agreed to serve, are nominated as the Joint Doctoral Dissertation Committee: Name and Academic Title (print or type) Department Institution Chair Co-Chair (if applicable) Approved SDSU: Approved UCSD: Track Director Track Director Program Director Dean, SDSU Graduate and Research Affairs Distribution: Dean, SDSU Graduate and Research Affairs Graduate Coordinator, UCSD Graduate Coordinator, SDSU Student SDSU/UCSD - JDP Form 2 HW 3/11

Office of Graduate Studies University of California, San Diego Graduate and Research Affairs San Diego State University La Jolla, California 92093 San Diego, California 92182 Joint Doctoral Program REPORT OF THE QUALIFYING EXAMINATION AND ADVANCEMENT TO CANDIDACY FOR THE DEGREE OF DOCTOR OF PHILOSOPHY IN: Public Health Epidemiology PU75 Name: Address: Last First Middle Red ID# UCSD PID # Number and Street City State Zip Code Telephone To: / Dean, SDSU Graduate and Research Affairs The members of the Joint Doctoral Dissertation Committee report that the candidate has completed all pre-dissertation requirements in the major and taken the qualifying examination(s) on (DATE). Committee Member (print or type) Signature Institution Approval of Qualifications Chair Co-Chair (if applicable) I request advancement to candidacy. I plan to complete my dissertation by: Student Signature Date Date Signed The committee recommends advancement to candidacy for the degree of Doctor of Philosophy in: Public Health (Epidemiology). Approved SDSU: Approved UCSD: Track Director Track Director Program Director The candidacy fee ($50.00) has been paid. Advancement to candidacy approved: Validated by UCSD Cashier Dean, SDSU Graduate and Research Affairs Distribution: Dean, SDSU Graduate and Research Affairs Graduate Coordinator, UCSD Graduate Coordinator, SDSU UCSD Registrar (original) Student SDSU/UCSD - JDP Form 3 HW 3/11

Office of Graduate Studies University of California, San Diego Graduate and Research Affairs San Diego State University La Jolla, California 92093 San Diego, California 92182 Joint Doctoral Program RECONSTITUTION OF THE DOCTORAL COMMITTEE FOR THE DEGREE OF DOCTOR OF PHILIOSPHY IN: Public Health - Epidemiology PU75 Name Last First Middle Red ID# UCSD PID# Address Number and Street City State Zip Code Telephone To: / Dean, SDSU Graduate and Research Affairs The student named requests reconstitution of his/her previously approved dissertation committee. Proposed title of dissertation: The following persons, who have agreed to serve, are nominated as the Doctoral committee: Name and Academic Title (print or type) Signature Department Institution Chair Co-Chair (if applicable) Approved SDSU: Approved UCSD: Track Director Track Director Program Director Dean, SDSU Graduate and Research Affairs Distribution: Dean, SDSU Graduate and Research Affairs Graduate Coordinator, UCSD Graduate Coordinator, SDSU Student SDSU/UCSD - JDP Form 4 HW 3/11

Office of Graduate Studies University of California, San Diego Graduate and Research Affairs San Diego State University La Jolla, California 92093 San Diego, California 92182 Joint Doctoral Program REPORT OF THE FINAL EXAMINATION AND FILING OF THE DISSERTATION FOR THE DEGREE OF DOCTOR OF PHILOSPHY IN: Public Health - Epidemiology PU75 Name Last First Middle Red ID# UCSD PID # Print name as it is to appear on the diploma: Mailing address for diploma: Number and Street City State Zip Code To: / Dean, SDSU Graduate and Research Affairs The members of the Joint Doctoral Committee report on the candidate s final examination: Committee Member (print or type) Signature Approved for Degree Chair Co-Chair (if applicable) The final examination and dissertation are unanimously not unanimously approved, and the candidate is recommended not recommended for the award of the degree of Doctor of Philosophy in: Epidemiology in the Department/Group of JDP Public Health as of (date) Dissertation title: Approved SDSU: Approved UCSD: Track Director Track Director Program Director The candidate has fulfilled all academic and registration requirements with the exception of depositing the dissertation with the libraries at UCSD and SDSU. Dissertation accepted for deposit. Graduate Division Office, SDSU Date Librarian, UCSD Date Conferral of the degree is recommended as of (month, day, year) Dean, SDSU Graduate and Research Affairs Distribution: Dean, UCSD OGS UCSD Registrar (Original) Dean, Graduate and Research Affairs, SDSU Graduate Coordinator, UCSD Librarian, UCSD Graduate Coordinator, SDSU Student Librarian, SDSU SDSU/UCSD JDP Form 5 HW 3/11

Page 1 Doctoral Student Progress Form Name: PID# Date of Admission: Deadlines: Advancement (+4): Graduation (+6): Date Residency Completed: SDSU: UCSD: Date Statistical Packages Completed: Date Teaching Completed: Date & Outcome (Pass/Fail) of Preliminary Examinations: Epidemiology: Biostatistics: Date & Outcome (Pass/Fail) of Qualifying Examinations: Written: Oral: Date of Advancement to Candidacy: Date of Graduation:

Page 2 COURSEWORK Students without a Masters degree in Epidemiology will take the following courses in addition to the Core Requirements listed below. Course No. Title of Course Grade Received Date Completed PH 601 Principles of Epi PH 602 Biostatistics PH 621 Infectious Dis. Epi. PH 622 Chronic Dis. PH 627 Adv. Stats in PH Core Requirements 43 units total Epidemiology (32 units) SDSU PH 623 PH 724 PH 800 Fall PH 800 Spring UCSD FPM258 A FPM258 B FPM258 C FPM259 A FPM259 B FPM259 C Epi Methods Adv. Epi Methods Epi Doctoral Seminar Epi Doctoral Seminar PH Doctoral Lecture Series I PH Doctoral Lecture Series II PH Doctoral Lecture Series III Applied Epi - Analysis Applied Epi - Writing Applied Epi - Presentation 2 study design courses from the following: FPM285 Design: Clinical Trials PH 823 Design: Case-Control PH 824 Design: Cohort Studies Biostatistics (11 Units) SDSU PH 628 PH 898 PH 898 Multivariate Statistics SAS Labs SPSS Labs 2 advanced biostats from the following: STAT 510 Applied Regression Analysis PH722 Analysis of Clinical Trials PH 826 Analysis of Cases Control study PH 827 Analysis of Cohort Studies

Page 3 Other Courses Taken: Course No. Title Grade / Units Date Completed Summary: # Core Units # Elective Units # Total Units Taken (Approx. # for JDP) Taken Required for JDP Taken Req. for Residency A. SDSU Semester Units --- --- 24 B. UCSD Quarter Units --- --- 36 C. UCSD Sem. Equiv. Units (B x 2/3) TOTAL Semester Units (A + C) --- --- --- (43) 15 --- Teaching: Course No. Title Date Completed Research Experience: Signature: Evaluator Date of Evaluation: