Embargo Request for a Thesis/Dissertation

Instructions

Purpose

This form is for students requesting a temporary embargo (delayed public access) of their thesis or dissertation.

This form confirms that:

Your final thesis or dissertation is complete and approved by your committee chair
You grant Boise State University non-exclusive permission to store and share your work publicly online, under specified conditions or after a predetermined embargo period.

You may request an embargo, in consultation with your supervisory committee, for the following reasons:

To protect sensitive or confidential information
To protect publication rights
To maintain intellectual property during that patent application process

In some cases, you may choose to submit a revised version of your thesis/dissertation that omits sensitive content instead of requesting an embargo.

Who Needs to Complete This Form?

You must complete this form only if you are requesting an embargo. All other students should complete the Access Agreement form.

When to Complete This Form?

You should complete this form after:

You have successfully passed your defense (final oral examination)
Your committee chair has reviewed and approved your document, including revisions after your defense. Your submission of this form confirms that you have approval from your committee chair (and co-chair, if applicable)

What You Need To Do

Complete all fields in this form and submit to the Graduate College. Incomplete or incorrectly approved forms will not be accepted and may delay your graduation.

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

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? Use the Boise State University Directory

Does your committee have a Co-Chair?

Yes

No

Co-Chair of Supervisory Committee

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

Metadata

Subject Category: Choose the subject category that best describes your work. Use the CIP classification list to indentify up to three levels of categorization. List your subject categories hierarchically with the highest level first. Use colons (:) as separators and include a minimum of two categories.

Examples:

Public Policy and Administration: Government Relations : Policy Analysis
Computing : Cybersecurity : Networking

Your Subject Category

Keywords: List up to four keywords that describe that main topics of your thesis or dissertation. These help others find your work through search.

Keyword 1

Keyword 2

Keyword 3

Keyword 4

Access Options

Note: Embargoes are temporary and limited to two years. Permanent restrictions are not permitted.

Access Choice (Choose One)

Embargoed Campus Access (2 Years): Restrict access to my thesis/dissertation for Boise State University users only (students, faculty, on-campus researchers, and interlibrary loan requests) for up to two years from the date of Graduate College approval.

Delayed Worldwide Access (2 Years): Restrict all public access (including campus access) for up to two years. After the embargo, release my work for worldwide access through ProQuest and ScholarWorks. This restriction also applies to printed library copies.

Justification for Embargo
Please briefly explain why an embargo is necessary for your thesis or dissertation (e.g., pending publication, intellectual property, sponsor agreement):

Student 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 approval from the Chair of the Supervisory Committee or their designee.

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.

Your committee chair must complete everything below this line. Altering or falsifying this section may result in disciplinary action. Please skip to the bottom of this form and click submit.

Committee Chair Certification

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

Committee Chair Approval

Approved

Not Approved

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

Hit the "Update" button to submit your decision.