Office of Doctoral Studies
Teachers College, Columbia University

Certification for Personal Exemption or Petition of Waiver
Doctor of Education - Ed.D.

When completed file in the Office of Doctoral Studies.

Part I Personal Exemption
Part II Waiver - On the reverse side of this form.


Candidate’s Name_______________________________ SS #No.__________________________

Address_________________________________________________________________________
(Number and Street) (City) (State) (Zip Code)

Day Phone No. ( )______________________

Department__________________________________ Adviser______________________________

Candidate please check one Ed.D. _____or Ed.D. _____ CTAS (College Teaching of an Academic
Subject)

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Part I - Certification for Personal Exemption
Personal Exemption

I hereby request a personal exemption from dissertation advisement for the following term(s)

Autumn________ Spring ________. Please indicate semester and year.

Reason for personal exemption (select one):

___I am not able to work on the dissertation and thus will not be seeking advisement
because of pressure of work.

___My dissertation is at a stage where advisement is not necessary.

___Professional or personal circumstances beyond my control.

A maximum of two semesters of personal exemption will be granted during your period of obligation.

Signed__________________________________ Date______________________________
(Candidate’s Signature)

Please Note: Retroactive Personal Exemptions requires your Adviser’s approval.

Signed____________________________________________Date_________________________
(Adviser’s Signature)

A Candidate who has a Student Loan and is granted a Personal Exemption must enroll as a
"Doctoral Candidate" IND 6000 and file a Certificate of Equivalency (available from the Registrar’s Office)
to be eligible for deferment of repayment. Contact the Registrar’s Office should you have any questions
about this procedure.

Reminder: A Final Oral Examination on the dissertation may not be held during the
period of Personal Exemption.

Part II - Petition for Waiver
Waiver

I hereby petition for a waiver from dissertation advisement for a period of year(s), beginning term:

Autumn________ Spring ________. Please indicate semester and year.

For the following reason (select one):

___Sustained Illness, your completion of this petition authorizes the College to make inquiry of a
physician whose name, address and telephone number are given in this petition.

___Military Service, attach a letter describing details and offering supporting documentation
from your service in the national interest.

___Inability of the Department to provide Advisement because of the illness or sustained absence
of key faculty member(s).

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When the Waiver form is completed have your Adviser and Department Chairperson
sign it before submitting to the Office of Doctoral Studies.
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Approval of Faculty Adviser:______________________________ Date___________________
(Signature)

Approval of Department Chairperson:______________________ Date
(Signature)

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Office Use Only
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Action of Doctoral Committee:__________________________________________________


For The Ed.D. Committee:______________________________ Date___________________


A Candidate who has a Student Loan and is granted a Waiver must enroll as a "Doctoral Candidate"
IND 6000 and file a Certificate of Equivalency (available from the Registrar’s Office) to be eligible
for deferment of repayment. Contact the Registrar’s Office should you have any questions about
this procedure.

Reminder: A Final Oral Examination on the dissertation may not be held during the
period of a Waiver.