Virginia Tech Graduate School ETD Approval Form

Virginia Tech Graduate School
Electronic Theses and Dissertation (ETD)
Approval Form (Revised 09-06-00)

Student Name: ___________________________________________________

ID#: ___________________________________________________

Department: ___________________________________________________

Your campus: ___Blacksburg, ___NVC, ___Other Extended Campus

Degree: ___ Bachelor's, ___ 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 Virginia Tech 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. My advisory committee and I agree that the above mentioned document be placed in the ETD archive with the following status: (choose one)

1. ___ Release the entire work immediately for access worldwide.

2. ___ Release the entire work for Virginia Tech access only for ___ 1 year, ___ 2 years, or ___ 3 years, after this time release the work for access worldwide. Extensions beyond 3 years require approval by the Graduate School of a written request describing the reason for delayed release.

3. ___ Release the entire work for Virginia Tech 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, 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):

___________________________________________

___________________________________________

___________________________________________

4. ___ 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 Virginia Tech. At the end of one year, either we or Virginia Tech 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 3 in writing.

Part B (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: _________________________________
are 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 final PDF copy or facsimile printed from the final PDF copy 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 ___________________________	Student ___________________________	Date ________
Signature	Printed name
Committee:
Chair _____________________________	Chair _____________________________	Date ________
Signature	Printed name
Co-Chair __________________________	Co-Chair __________________________	Date ________
Signature	Printed name
Member ___________________________	Member ___________________________	Date ________
Signature	Printed name
Member ___________________________	Member ___________________________	Date ________
Signature	Printed name
Member ___________________________	Member ___________________________	Date ________
Signature	Printed name
Member ___________________________	Member ___________________________	Date ________
Signature	Printed name

Revised 07-02 tl

Student Name:	___________________________________________________
ID#:	___________________________________________________
Department:	___________________________________________________
Your campus:	___Blacksburg,	___NVC,	___Other Extended Campus
Degree:	___ Bachelor's,	___ Master's,	___ Doctoral degree
Document Type:	___ Project Report,	___ Thesis,	___ Dissertation
Document Title:
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________

1.	___	Release the entire work immediately for access worldwide.
2.	___	Release the entire work for Virginia Tech access only for ___ 1 year, ___ 2 years, or ___ 3 years, after this time release the work for access worldwide. Extensions beyond 3 years require approval by the Graduate School of a written request describing the reason for delayed release.
3.	___	Release the entire work for Virginia Tech 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, 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):
		___________________________________________
		___________________________________________
		___________________________________________
4.	___	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 Virginia Tech. At the end of one year, either we or Virginia Tech 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 3 in writing.