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10 - STUDENT - Dissertation Copyright Declaration


									           Dissertation Copyright Declaration (to be completed by the STUDENT)
This form is completed by the student, before the final oral examination is being arranged (in the case of a doctoral
degree it should occur at the time an external examiner is being arranged). The student completes the declaration
and submits a copy to their supervisor at that time. A copy of this declaration must be given to FGS at the time the
final approved dissertation/dissertation is submitted to the DTheses repository.

This dissertation is a public document and therefore it is necessary to ensure that due
acknowledgement is made, where appropriate, before it is published.

Author of Dissertation: Student Name
Name of Degree: Choose an item.
Anticipated Date for Graduation: Click here to enter a date.

Complete only the statement that applies:

I, (insert full name), confirm that my dissertation (including any electronic
attachments) does not contain material for which the copyright belongs to a third


I, (insert full name), confirm that for all third party copyright material in my
dissertation (including any electronic attachments), I have either:

             a) Obtained written permission to use the material and have submitted
         copies of each permission to my supervisor as well as kept copies for my
         records (NOTE: do not include permission forms/emails in the body of your


             b) “Blanked out” third party material from the copies of the
         dissertation/dissertation; fully referenced the deleted materials and where
         possible, provided links (urls) to electronic sources of the material.

I certify that the copies of my dissertation deposited with the University will be the
same as the final officially approved version of my dissertation.

Signature of Author: ________________________________                                Date: Today’s Date

Last Updated: 2011-05-11         Athabasca University, Faculty of Graduate Studies                        Page 1 of 1

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