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Thesis Authorization (Montana Tech)

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Electronic Thesis Authorization Form
It is the Department’s responsibility to pay for one archival print copy for the library. The
Department may also choose to pay to order additional print copies.
The Department Head must sign this form to authorize E-Thesis submittal and
payment for library copy and any orders for print copies.
The Banner Index number(s) to be charged for the copies must be provided on this
form.
Submit this form to Trisha Southergill, MUS 306 or psouthergill@mtech.edu
GRADUATE STUDENT INFORMATION
Last Name
First Name
Middle Name
THESIS TITLE
LIBRARY COPY
Note: The Department will be responsible for one (1) library archival copy.
Banner Index Code for archival copy:
DEPARTMENT COPY/COPIES
The Department/Grant Awardee will pay for the following
department copies:
Banner Index Code for department copies:
MASTER’S CANDIDATE COPY/COPIES
The Department/Grant Awardee will pay for the following
Candidate copies:
Banner Index Code for Candidate copies:
The Candidate will pay for the following personal copies
(with a personal check made payable to Montana Tech):
DEPARTMENT AUTHORIZATION (Required)
Department:
Ext:
Department Head Name:
Department Head Signature:
Grant Awardee Name:
Grant Awardee Signature:
REV: 8/22/14
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Thesis Authorization (Montana Tech)

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Completed 25 July 2020

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