Thesis Submission Form
This form serves as the official record of thesis submission to the Office of Graduate Studies.
This form is NOT included in the thesis.
The information provided below should INCLUDE THE SAME INFORMATION approved on the title page of your thesis
TYPE this information for legibility
Student ID # ___________________________ Semester & Year of Graduation ____________________
First Name __________________________ Middle Name _________________ Last Name _______________________________
Degree Type: ________________________ Degree Program ___________________________ College _____________________
Keywords or Phrases concerning subject of thesis (separated by commas, 256 character max):
1. I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of
each third party copyrighted matter to be included in my thesis allowing distribution as specified below.
2. I certify that the version I submitted is the same as the final copy approved by my advisory committee.
3. I hereby grant to MSU Billings and its agents the non-exclusive license to archive and make accessible my thesis in whole or
in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis. I also
retain the right to use in future works (such as articles or books) all or part of the thesis.
Student and Committee Agreement (select one of the following):
1. Release the entire work, which includes any supplementary material, immediately for access worldwide.
2. Secure the entire work, which includes any supplementary material, for patent and/or proprietary purposes for a period of
one year. At the end of the one year secure period, the work will be handled under option 1 above.
I intend to submit my thesis in: Print Electronic format
I have delivered a USB drive containing the electronic files to the Office of Graduate Studies with all the appropriate
Received Date: ___________________________
Print Copy Submission:
I have delivered three (3) paper copies on the required paper to the Office of Graduate Studies with all the
Received Date: ____________________________
Personal Print Copies
I intend to purchase _____ print copies. I have provided the copy/copies to the Office of Graduate Studies and paid
the binding fee(s). I understand that I am responsible for postage fees for mailing.
_________________________________ ________________________________________ _________________
Student/please print Signature Date
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