Application to Embargo / Restrict a Thesis
Please return completed application form to the Research office
To be completed by the student
Student ID Number
YO U R D E TA I L S
Family name
First name
Number and street
Telephone
Suburb
Cellphone
City
Post code
Country
Email
Alternative contact
Thesis title
Company sponsor
Submission date
First Masters
MPhil
PhD
MSc
EdD
SJD
School / Faculty
Department
I request the restriction of the electronic thesis for six months from the date of submission of the hard bound document.*
OR
I request the embargo of this hard bound and electronic thesis for
months from the date of submission of the document as:
It is pending publication
I wish to protect pre-existing commercial secrets of a sponsor
It is pending the filing of a patent
There is a pre-existing contractual obligation
To allow a sponsor to comment
A restriction is necessary under the Privacy Act 1993 or the Official Information Act 1982
To protect pre-existing traditional knowledge of a whanau/hapu/iwi
Supporting documentation must be attached
Student signature
Date
To be completed by Chief Supervisor
Name
Signature
Office use only
To be completed by the Chair of Department
Name
Signature
Director Research & Innovations (if contractual obligation applies) Signature
Pro Vice-Chancellor (Postgraduate)
Original to be kept in Research Office. Copies to: Postgraduate Studies / Assessment Office, Student and Library
ud.co.nz
10292
Note: If embargo is approved, only the author, title, abstract and other meta-data of the full electronic copy held by the University will be
publicly accessible through the University’s electronic repository.