Application to Embargo / Restrict a Thesis Please return completed application form to the Research office
To be completed by the student
Student ID Number Y O U R D E T A I L S Family name First name Number and street Telephone Suburb Cellphone City Post code Email Country 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/Head of School
Name
Signature
Director Research & Innovation (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
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. ud.co.nz