Fillable UNCW School of Health & Applied Human Services (University of North Carolina at Wilmington)

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UNCW School of Health & Applied Human Services (University of North Carolina at Wilmington)

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Updated 5/2019
UNCW School of Health & Applied Human Services
Gerontology Program
Electronic Final Project Form
Student Name:
Student ID#:
Document Title:
Student Agreement:
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 final
project, allowing distribution as specified below. I certify that the version I submitted is the same
as that approved by my advisory committee.
I hereby grant to UNCW and its agents the non-exclusive license to archive and make accessible,
under the conditions specific below, my final project in whole or in part in all forms of media,
now or hereafter known. I retain all ownership rights to the copyright of the final project. I also
retain the right to use in future works (such as articles of books) all or parts of this final project.
Student and Committee Agreement:
Part A. My advisory committee and I agree that the above-mentioned document be placed in the
ETD archive with the following status: (choose one)
Release the entire work immediately for access worldwide.
Release the entire work for UNCW access only for:
1 year
3 years, or
indefinitely
Release the entire work for UNCW access only, while at the same time releasing only the
following parts of the work (e.g., because other parts relate to publications) for
worldwide access (separate files must be submitted to use this option): for
1 year
3 years, or
indefinitely
UNCW Gerontology Program
Electronic Final Project Form
Updated 5/2019
Files named as follows (i.e., separate PDF or multimedia files):
Secure the entire work for patent and/or proprietary purposes for a period of one year.
During this period the copyright owner also agrees not to exercise her/his ownership
rights, including public use in works, without prior authorization from UNCW. At the
end of one year we may request, in writing, an extension for one additional year. At the
end of the secure period, the work will be handled under option 1 above, unless we
request option 2 or 3.
Part B. (Optional) For any release other than option 1, the Graduate School requests that you
name a proxy to cover cases such as if the student or committee signing this form becomes
inaccessible. Any of the following people (indicated by their names) is authorized to serve as
proxy for changes in availability. Submissions by any of these proxies signing are officially
recognized just as if the student and full committee signed. For example, it is suggested that the
committee chair be a proxy.
Printed name of proxy:
Printed name of proxy:
Review and Acceptance:
The final ETD of the above-mentioned document has been reviewed and accepted by the
student’s advisory committee. The undersigned agree to abide by the statements above and agree
that this Approval Form updates any and all previous Approval Forms submitted heretofore.
Student Signature: Student Name:
Date:
(Typed Name)
List Committee Members (Typed):
Chair
Member
Member
Member
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UNCW School of Health & Applied Human Services (University of North Carolina at Wilmington)

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Completed 24 July 2020

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