First Masters Thesis Submission Form
Assessment and Graduation Office
Student and Academic Services Division
The University of Waikato
Private Bag 3105
Hamilton 3240, New Zealand
Els Brown
Phone
+64 7 838 4466 ext 8018
Fax
+64 7 838 4539
Email
[email protected]
SECTION 1 – TO BE COMPLETED BY THE CANDIDATE
Student ID
Degree
Family name
First name/s
Postal address
Phone
Email
Thesis Title:
**** IS THIS MASTERS THESIS TO BE EMBARGOED****
Yes
No
If Thesis is to be EMBARGOED, have you already applied to do so
Yes
No
Declaration concerning the use of animals or human subjects or gene modification
1.
2.
a) My research involved experimentation on animal subjects
Yes
No
b) My research involved participation by human subjects
Yes
No
c) My research involved genetic modification
Yes
No
If “Yes” to any above:
I certify that the research I have undertaken in connection with my thesis has been approved by the appropriate
University of Waikato committee, or another statutory committee authorised to approve the research.
Please name committee:…………………………………………………………………………………………………………….
I have submitted two soft-bound copies of my thesis
Date
N.B: Two hard-bound copies are required to be submitted once the thesis has been examined
I have submitted a digital copy of my thesis to the University’s Research
Commons website and confirm that this copy of the thesis is the same as
the soft-bound copies
Date
I have completed a completed Library Deposit Authorisation.
Date
Student Signature
Date
SECTION 2 – TO BE COMPLETED BY THE SUPERVISOR
I confirm that this thesis is, in my opinion, ready for examination.
Yes / No
I confirm that this thesis embodies the student’s own work carried out
under my direct supervision
Yes / No
Name of Chief Supervisor
Signature of Chief Supervisor
Date
FACULTY
DEPARTMENT / PROGRAMME
If NO attach
explanation on separate sheet
If NO attach
explanation on separate sheet
Office Use Only
Submission Date
Authority to Copy
Received two soft copies
of the thesis
/
/
YES
/ NO
Debt check OK
/
/
Extension Date
/
/
Receipt Issued
/
/
Research Commons
Checked
/
/
Research Commons
Released
/
/
Is this thesis to be
Embargoed
YES
/ NO
Embargo expiry date
/
/
Received two hard bound
copies
/
/
Declaration received
YES
/ NO
JADE Logged
/
/
2 soft copies sent to
Department/Programme
/
/
YES /
NO
Grade & completion
received and logged and
hard copy sent to
department
Initials:
One copy of thesis &
Deposit Form lodged
with Library
/
/
/
/