Dissertation Information Form

Dissertation Information Form
Instructions
Do not hand write - Must be typed
This form must be sent to the Office of Graduate Studies along with your dissertation. A Dissertation Committee Approval Form must also be
included in addition to any supplementary materials indicated below. Your dissertation should be attached as a separate PDF document. All
attachments should be sent in one email to Graduate Studies. The SJSU Master's Thesis and Doctoral Dissertation Guidelines, including detailed
dissertation submission instructions, and the email address to which your dissertation submission should be sent are available on the Graduate
Studies website (www.sjsu.edu/gup/gradstudies/thesis/index.html).
Reading the dissertation guidelines is mandatory. Please check the box below to acknowledge that you have read the SJSU dissertation
guidelines and that Graduate Studies does not serve as an editor.
Student signature ____________________________
I have thoroughly read through the entirety of the dissertation guidelines.
Student Information
Last Name
First Name, M.I.
Student ID
Previous Name, if any
Email Address
Daytime Phone
Dissertation Information
Dissertation Chair Name
Dissertation Chair Email Address
Department
Semesters & Years Enrolled in Thesis 599
Title of Dissertation
Style Manual Used and Additional Documents Needed
By agreement between the Office of Graduate Studies and the campus doctoral programs, all dissertations will be composed according to APA
guidelines.
Please verify that you have attached all the required documents by checking the boxes that apply to you.
IRB Human Subject research approval letter
IACUC Animal Care and Use research approval letter
Permission(s) to reproduce copyrighted material in your dissertation
FOR OFFICE USE ONLY - DO NOT WRITE BELOW THIS LINE
Approved for publication
Not approved - resubmit next semester
Date GAPE notified ________________
Pages with corrections/comments
Dissertation Information Form
Version: 07-2016
Dissertation Committee Approval Form
Instructions
Do not hand write - Must be typed
Signatures from all committee members must be present when your dissertation is submitted to the Office of Graduate Studies for review. Graduate
Studies will accept either electronic or hand-written signatures as long as all signatures appear together on the same form. This form must be included
with the Dissertation Information Packet. The SJSU Master's Thesis and Doctoral Dissertation Guidelines, including detailed dissertation submission
instructions, are available on the Graduate Studies website (www.sjsu.edu/gup/gradstudies/thesis/index.html).
University policy S14-10 requires that a minimum of three individuals serve on a student's dissertation committee. The majority of the committee
members must be SJSU tenured or tenure-track faculty. The chair of the dissertation committee must be a full time, tenured or tenure-track SJSU faculty
member. Faculty participating in the Faculty Early Retirement Program (FERP) are considered active faculty members and, as such, can function as the
dissertation chair. Emeritus SJSU professors may serve in any capacity as long as they have permission from the college dean. Non-faculty members
must be recognized experts in the subject matter of the dissertation. If the dissertation committee includes an off-campus member, please specify the
affiliation (e.g., Mr. Marvin King, M.A., CEO of ABC Corporation) in the department field and include a resume or curriculum vitae (CV) as an attachment.
If there are more than four committee members, please fill out an additional form.
Student Information
Student's Full Name
Student ID #
Email Address
Phone Number
Dissertation Information
The Undersigned Dissertation Committee Approves the Dissertation Entitled
Submitted to the Department or School of
Dissertation Committee Signatures
Dissertation Chair (print) ____________________________________________________ Department _____________________________
Dissertation Chair (signature) _________________________________________________ Date
_____________________________
Second Reader (print) ______________________________________________________
Department _____________________________
Second Reader (signature) __________________________________________________ Date
_____________________________
Third Reader (print) ________________________________________________________ Department _____________________________
Third Reader (signature) ____________________________________________________ Date
_____________________________
Fourth Reader (print) _______________________________________________________ Department _____________________________
Fourth Reader (signature) ___________________________________________________ Date
_____________________________
Dissertation Committee Approval Form
Version: 07-2016
Dissertation License Agreement
Instructions
Do not hand write - Must be typed
This form is to be submitted to the Office of Graduate Studies along with your doctoral dissertation. This form must be included with the rest of the
documents in the Dissertation Information Packet, which includes the Dissertation Information Form, and the Dissertation Committee Approval Form.
The SJSU Master's Thesis and Doctoral Dissertation Guidelines, including detailed dissertation submission instructions, are available on the Graduate
Studies website (www.sjsu.edu/gup/gradstudies/thesis/index.html).
Please make sure to select one of the listed access options for your dissertation, and sign and date this form either with a digital signature or a hand
written signature. Note that if you choose to embargo your dissertation, you may do so in 6-month increments not to exceed 60 months (five years).
Dissertation Information
Student's Full Name ___________________________________________________________________________________________________
Expected Graduation Date ________________________
Dissertation Title ______________________________________________________________________________________________________
Access Options
With the exception of the embargo period and types specified below, by signing and submitting this agreement, I grant San Jose State University
(SJSU) the non-exclusive license to archive and make accessible my dissertation in whole or in part in all forms of media now or hereafter known for
educational, research, and scientific nonprofit uses during the full term of copyright. I retain all other ownership rights to the copyright including the
right to use in future works (such as articles or books) all or part of my dissertation. I represent that the submission is my original work, and that I
have the right to grant rights contained in this license. I also represent that my submission does not, to the best of my knowledge, infringe on
anyone's copyright and that I have obtained written permission from the owner(s) of any third party copyrighted matter included in the dissertation. I
certify that the digital version that I have submitted is the same as that approved by my dissertation advisory committee and the Office of Graduate
Studies.
My dissertation will be placed in San Jose State University's institutional repository, with the following status (you must choose from one of the
four options below):
Release the dissertation immediately for access worldwide.
Release the dissertation immediately for San Jose State University access only.
Embargo (delayed release) the dissertation for patent and/or proprietary purposes and release the dissertation for access worldwide
upon expiration of the embargo after the embargo period of (select one).
Please confirm
Embargo (delayed release) the dissertation for patent and/or proprietary purposes and release the dissertation for SJSU access only
upon expiration of the embargo after the embargo period of (select one).
Please confirm
Student Signature
I will clearly be identified by name as the author of the submitted work in the institutional repository. SJSU will not make any alteration
other than as allowed by this license to my submission.
Student Signature _____________________________________________________________________________________________________
Date ________________________
You may sign this form with a digital signature or a hand-written signature.
Dissertation License Agreement
Version: 07-2016