Nomination of Examiners and Convenor Form

📋 Instructions for Completion

This form must be completed by the Principal Supervisor in consultation with the supervisory team.
Attached are copies of the Internal and External Examiner Information Forms (Form 1A, Form 1B, and Form 1C).
Required attachments:
- Current CV for EACH EXTERNAL examiner (mandatory)
- CV not required for internal examiners (already on file)
Submit completed form with attached CVs to CPGS at least 8 weeks before intended thesis submission.

👤 Section A: Candidate Information & Details

Candidate Name *

Student ID *

Faculty / School *

Program *

Research Field / Discipline *

Thesis Title *

Expected Submission Date *

👨‍⚖️ Section B: Convenor Nomination & Details

Select from the list of convenors available on the CPGS website. The Convenor must be outside the supervising department.

Convenor Full Name *

Email Address *

Faculty / Department *

⚠️ Section C: Conflict of Interest Declaration

Note: The Principal Supervisor confirms that potential examiners have been contacted and have declared the following (please indicate for each examiner):

Potential Conflict	Internal Examiner (MSc & PhD)	External Examiner (MSc & PhD)	International Examiner (PhD only)
No conflict of interest
Has NOT supervised the candidate
Has NOT co-authored publications with candidate in last 3 years
Has NOT co-authored publications with supervisor(s) in last 3 years
NO family relationship with candidate or supervisors
NO close personal friendship with candidate or supervisors
NO financial interest in candidate's research outcomes
NOT from candidate's previous institution (if applicable)
Has NOT examined candidate's previous thesis (if applicable)
NO collaboration on current research projects with supervisory team
NO other conflicts that could compromise objectivity
Examiner has confirmed availability within 6-8 weeks

✓ Section D: Supervisor Checklist (SMDD 2.3.6 & 2.3.7 Compliance)

Note: The Principal Supervisor confirms the following (please indicate by ticking √ or X):

Checklist Item	Yes (✓)	No (✗)
Examiners have doctoral degrees (or approved equivalent)
Examiners are from fields related to the candidate's research
Internal examiner has supervised Masters/PhD candidates to completion
External examiner has supervised Masters/PhD candidates to completion
Internal examiner has peer-reviewed publications in last 3 years
External examiner has peer-reviewed publications in last 3 years
Internal examiner has examined theses at the appropriate level
External examiner has examined theses at the appropriate level
Both examiners are actively engaged in research
No conflicts of interest exist
Both examiners have confirmed availability within required timeline
CV attached for external examiner
Convenor nominated
All information provided is accurate and verified

📎 Required Attachments

External Examiner CV(s) * Select File

Internal Examiner Information Form (F01A) Select File

External Examiner Information Form (F01B) Select File

International Examiner Information Form (F01C) Select File

✍️ Section E: Verification

The nomination of the examiner has been reviewed and verified:

Principal Supervisor Name *

Date *

Dean of Faculty Name

Dean Approval Date

ℹ️ Once signed by the Dean of Faculty, this form will be sent to CPGS (cpgs@qiu.edu.my) for further processing.

📜 Principal Supervisor Declaration

I hereby confirm that all information provided in this nomination form is accurate, complete, and has been verified. I certify that the nominated examiners and convenor meet all QIU requirements and have no conflicts of interest. This form has been completed in consultation with the supervisory team.