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