Thesis/Dissertation Binding Form

NOTE: Once the document has been approved by the thesis or dissertation committee and the Graduate Dean, the thesis or dissertation is considered a final document. No changes to the document can be made by the author after approval by the committee and Graduate Dean.

NAME: (Last, First, Middle)

NAME ON TITLE PAGE:
(If different than above, type exactly as it appears on the thesis/dissertation title page -- Last, First, etc.)

BIRTHDATE: (mm/dd/yyyy) STUDENT ID #:
(Used for cataloging purposes with name conflicts)

MASTERS THESIS :

DOCTORAL DISSERTATION:

OTHER DEGREE/PROGRAM:

THESIS DISSERTATION TITLE:

CHAIR OF THE EXAMINING COMMITTEE:

EXAMINING CHAIR'S DEPT. OR PROGRAM:

NUMBER OF THESIS/DISSERTATION COPIES SUBMITTED:
(3 copies of a thesis or dissertation must be submitted to the Library. PLEASE NOTE that Molecular Biology and Astronomy require 4 copies. DO NOT INCLUDE YOUR PERSONAL COPIES ON THIS FORM!)

BUSINESS OFFICE TRANSACTION #: AMOUNT PAID:
(Receipt number given by the Business Office when fees are paid)

UMI FORM COMPLETED FOR DISSERTATIONS: Yes No

LOCAL CONTACT INFORMATION:
(Person we may contact locally in case there are processing problems.)

NAME:

PHONE:

EMAIL:

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