Embargo Request for a Thesis/Dissertation

Instructions

Purpose: The Embargo Request for a Thesis or Dissertation (ERTD) form is the official document by which a graduate student (a) provides necessary certifications for the final version of their thesis or dissertation, and (b) grants the university a non-exclusive right to archive the thesis or dissertation and make it publicly available under specified conditions or after a pre-determined embargo period. Graduate students, in consultation with their Supervisory Committee and Department Chair, may propose to embargo their thesis or dissertation to protect sensitive information, to protect publication rights, or to maintain intellectual property during the patent application process. If it is determined that an embargo is not a good option for the student, a version of the thesis or dissertation that omits sensitive information may be submitted in its place.

Scope: A fully executed ERTD is a requirement for all graduate students who produce a thesis or dissertation as part of their degree program and request an embargo period. The ERTD requirement is not considered satisfied and a student cannot be cleared for graduation the Graduate College has reviewed and approved the ERTD.

Procedure: The ERTD is executed after the student has passed the final oral examination (defense) and the thesis or dissertation has received approval from the Chair of the Supervisory Committee. The student is responsible for (a) completing all sections of this form, (b) requesting the approval of the Chair of the Supervisory Committee and the Chair of the Department or Program, and (c) submitting the ERTD to the Graduate College. The Graduate College will not accept an ERTD that is incomplete or does not have the correct approvals.

Student Information

First Name

Middle Name (if you do not have a middle name, please leave this section blank)

Last Name

Student ID Number

BroncoMail Email Address

Program Information

Graduate Program

Other

Program Coordinator Name

Program Coordinator Email
Not sure? Boise State University Directory

Catalog Year

Anticipated Graduation Term

Thesis/Dissertation Information

Document Type

Thesis

Dissertation

Title of Thesis/Dissertation

Date of Defense

Chair of Supervisory Committee

Committee Chair Email
Not sure? Boise State University Directory

Does your committee have a Co-Chair?

Yes

Co-Chair of Supervisory Committee

Co-Committee Chair Email
Not sure? Boise State University Directory

Metadata

Subject Category: Choose a subject category that best describes your thesis or dissertation. You can view subject categories at the following URL: Classification of Institutional Programs. Subject categories are given in a hierarchical format with three levels for most disciplines. Express your subject category in the space below by starting with the highest level, and then listing the second level, and then the third level; use colons (:) as separators. If it is not possible to refine your subject category to the third level, either because a third level is not listed for your discipline or you simply do not feel that a third level is warranted, you should stop at the second level.

Example (3 levels): Public Policy and Administration - Government Relations - Policy Analysis

Example (2 levels): Computing - Cybersecurity - Networking

Subject Category

Keywords: A keyword is a significant or memorable word or term in the title or abstract of a thesis or dissertation that helps convey the topic. Please list up to four keywords that you feel best describe your thesis or dissertation.

Keyword 1

Keyword 2

Keyword 3

Keyword 4

Student Access Choice and Certifications

Access Choice

I hereby grant to Boise State University and its agents the non-exclusive license to archive and make accessible my thesis or dissertation in whole or in part, in all forms of media, now or hereafter known, subject to the conditions specified below. I retain all ownership rights to the copyright of my thesis or dissertation. I also retain the right to use all or part of my thesis or dissertation in future works (such as articles or books).

Release my entire thesis or dissertation immediately for access only by Boise State University students and employees or persons using Boise State University facilities including interlibrary loan, for a period not to exceed two years measured from the date that my thesis or dissertation is signed by the Graduate College on the Final Reading Approval form.

Release my entire thesis or dissertation for worldwide access but only after a period not to exceed two years measured from the date that my thesis or dissertation is signed by the Graduate College on the Final Reading Approval form; this two-year embargo also applies to any paper copies of my thesis or dissertation deposited in the library.

Justification

Certifications

I certify that the version of my thesis or dissertation that I am submitting for review and approval by the Graduate College is the same as the version that received final reading approval from the Chair of the Supervisory Committee or their designee as indicated by the signature on the Final Reading Approval form.

I certify that I am the sole proprietor of all rights in and to my thesis or dissertation and I have full power and authority to grant the rights described herein.

I certify that, if appropriate, I have obtained and attached a written permission statement from the owner(s) of each copyrighted work reproduced in my thesis or dissertation, and each permission statement allows access as specified below.

Student Electronic Signature: By entering your name below, you are acknowledging that you are signing this form.

Student Signature Date

What is your role? I am the:

Student

Department Chair

Program Coordinator

GSSC Representative

Additional Signatures
This section is for the Department Chair or Program Coordinator Approval only. If you are the student filling out this form, continue to the bottom of the page to the submission section and click submit.

Department Chair/Program Coordinator Approval

Approved

Not Approved

Department Chair/Program Coordinator Electronic Signature: By entering your name below, you are acknowledging that you are signing this form.

Signature Code
Enter the signature code number you received in the approval email.

Electronic Signature - GSSC Representative Approval

GSSC Notes

Submit this form now using the Submit button below.

Render my signature and decision by hitting the Update button below.