Fillable FILLABLE Thesisand Dissertation Reproduction Approval Form (Central Connecticut State University)

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FILLABLE Thesisand Dissertation Reproduction Approval Form (Central Connecticut State University)

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Elihu Burritt Library Thesis and Dissertation Reproduction Approval Form
Student Name:
(Last)
(First)
(Middle)
(Year of Birth)*
E-mail Address:
Phone Number:
Type:
⃝ Master’s Thesis
⃝ Ed.D. Dissertation
Title:
Student Agreement for Remote Access Through Digital Repository
Please check one of the choices below indicating whether you give your permission to the Elihu
Burritt Library to provide remote access to your theses or dissertation through the Digital
Repository.
⃝ I give permission / ⃝ I do not give permission to Elihu Burritt Library, Central Connecticut
State University to make available a complete copy of my thesis or dissertation through the
Digital Repository.
Changes to this Digital Repository agreement should be made in writing to: Information Systems and Resources,
Elihu Burritt Library, Central Connecticut State University; 1615 Stanley Street; New Britain, Connecticut 06050
Student Agreement for Access Through Interlibrary-Loan
Please check one of the choices below indicating whether you give permission to the Elihu
Burritt Library to copy or loan your thesis or dissertation through Interlibrary Loan.
⃝ I give permission / ⃝ I do not give permission to Elihu Burritt Library, Central Connecticut
State University to make available a complete copy of my thesis or dissertation, either
electronically or in hardcopy, when requested by another institution through Interlibrary Loan.
Changes to this Interlibrary Loan agreement should be made in writing to: Interlibrary Loan Office, Elihu Burritt
Library, Central Connecticut State University; 1615 Stanley Street; New Britain, Connecticut 06050
Student Signature
Thesis advisor’s signature is required for remote access through the Digital Repository and
for access through Interlibrary-Loan
Thesis Advisor Signature
Dean, School of Graduate Studies Signature
Questions?
Please feel free to contact Steven Bernstein, Associate Librarian for Cataloging & Metadata with
any questions you may have. He can be reached at Bernsteinstj@ccsu.edu or (860) 832-2079.
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FILLABLE Thesisand Dissertation Reproduction Approval Form (Central Connecticut State University)

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Completed 22 July 2020

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