FIU University Graduate School
Electronic Thesis and Dissertation (ETD) Submission
Approval Form

Student Name:	___________________________________________________
ID#:	___________________________________________________
Department:	___________________________________________________

Degree:	___ Master's	___ Doctoral degree
Document Type:	___ Project Report	___ Thesis	___ Dissertation

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 thesis, dissertation, or project report, 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 Florida International University and its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report 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, dissertation, or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report.

Student and Committee Agreement:

Part A. We agree that the above-mentioned document be placed in the ETD archive with the following status: (choose one of 1, 2, 3, or 4)

___	1.	Release the entire work immediately for access worldwide.
___	2.	Release the entire work for Florida International University access only.
___	3.	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 Florida International University. At the end of the one-year period, either we or Florida International University may request an automatic extension for one additional year. At the end of the one year secure period (or its extension, if such is requested), the work will be handled under option 1 above, unless we request option 2 or 4 in writing.
___	4.	Release the entire work for Florida International University access only, while at the same time releasing the following parts of the work only (e.g., because other parts relate to publications) for worldwide access (check all that apply or provide an attached list):
	___	Abstract and key bibliographic data (i.e., from submission form)
	___	Files named as follows (i.e., separate PDF or multimedia files):
		________________________________________________
		________________________________________________
		________________________________________________

Part B. (use only if you checked 2 or 4 above). Our preference regarding being contacted to see if we will give written approval to expand the access to the above mentioned document is: (choose one)

___	in 1 year
___	in 3 years
___	probably never (e.g., since a publisher will release a book version soon)

Future Mailing Address:

_______________________________________________________________
Street Address

_______________________________________________________________
City                State                    Zip or Postal Code

_______________________________________________________________
Country

Effective date for future mailing address (mm dd yy)    _________________________
Home telephone number _________________Business/other ___________________
Email ______________________________________________________________

Part C (optional proxy). To cover cases such as when one or more of the student and committee signing this form becomes inaccessible, each of the following people (indicated by their names printed)

Printed name of proxy:	____________________________________
Printed name of proxy:	____________________________________
Printed name of proxy:	____________________________________

is authorized to serve as a proxy in submitting future versions of this form, so submissions with 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.

Review and Acceptance:

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.

Signed:	____________________________________	________________
	(student)	(date)
Committee:	____________________________________	________________
	____________________________________	________________
	____________________________________	________________
	____________________________________	________________
	____________________________________	________________
	(committee member)	(date)

Approvalform.htmlRevised December 6, 2000