Graduate Release Form

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GRADUATE STUDENT RELEASE FORM Before graduating, you must obtain release authorizations from the Department of Computer Science (DCS) Business Office and the Academic Office. We also require that you grant us the right to publish your thesis as a DCS report. You must return all borrowed equipment to the department. You must dispose of all your files on the computer system by copying them to a personal tape, transferring them to another directory, archiving or deleting them. STUDENT INFORMATION Name Current Local Address University ID No. New Permanent Address Current Office Phone No. Current Home No. Current Email Address Last Date at Siebel New Office Phone No. New Home No. New Email Address Effective Date for New Address AUTHORIZATIONS Initials 1. Business Office (2110 Siebel Center) Date Sign-on, Printing Access, Copy Codes Equipment 2. Business Office (2110 Siebel Center) Address & Tech Report 3. Academic Office OVER 201 North Goodwin, Siebel Center, Urbana, Illinois 61801 9/02 DEGREE INFORMATION Degree Thesis Adviser Area of Research (Please check one) Artificial Intelligence Computer Architecture & Systems Distributed Systems & Networks Programming Languages Date of Degree De Jure Adviser     Biomedical Computing Computer-Assisted Instruction Numerical & Scientific Computing Real-Time Computing Systems     Communication Networks     Computer-Aided Design of Digital Sys. Databases & Information Systems     Computer Graphics Operating Systems Software Engineering Parallel Computing Theoretical Computing Thesis Title DEPARTMENTAL RIGHT TO PUBLISH THESIS AS A REPORT I hereby grant to the University of Illinois (and its Department of Computer Science) the right to publish my thesis as a Department of Computer Science report and to reproduce and assign to others the right to reproduce said report for educational and research purposes Signature Date EMPLOYEE INFORMATION (REQUIRED & CONFIDENTIAL) The University never releases the information on an individual basis. It is helpful in guiding decisions of subsequent graduate students and in assessing the computer science employment market in general. Name of Employer Type of Work No. of Interviews No. of Offers With Whom Location 201 North Goodwin, Siebel Center, Urbana, Illinois 61801 9/02

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