Thesis/Dissertation Redaction Request

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Thesis/Dissertation Embargo Extension or Redaction Request

STUDENT INFORMATION

Author*

First Name

Initial (optional)

Last Name

Degree Program*

Graduation Date*

Degree*

Email Address*

Phone*

STUDENT REQUEST

What are you requesting?*

Request Embargo Extension Request Page(s) Substitution

EXTENSION PERIOD

Select Timeframe*

One Year Extension Request Three Year Extension Request Five Year Extension Request Indefinite

MUST Attach Supporting Documents if Indefinite is Chosen No File Chosen

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Reason*

Explain*

PAGES TO BE SUBSTITUTED

Pages to be substituted (page numbers and brief description of content):*

Reason for substitution:*

Attach Pages to Substitute No File Chosen

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Attach Supporting Documents No File Chosen

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AUTHOR

I request permission to substitute the page(s) listed above. I understand that, if the request is approved, I must submit Scholarworks@uno.edu a PDF of the approved modified thesis/dissertation*

[clear]

Date/Time*

Your request will be reviewed by the Graduate School. Additional approval by graduate faculty & advisors may be necessary. Submitting this form does not guarantee approval.

THESIS/DISSERTATION ADVISOR (only if still on the UNO faculty)

Thesis/Dissertation Advisor*

APPROVED DENIED

Denial Reason

Date/Time

GRADUATE COORDINATOR OF DEGREE PROGRAM

Graduate Coordinator Decision*

APPROVED DENIED

Denial Reason

Date/Time

GRADUATE SCHOOL REVIEW

Who would you like to email this form to?

Email Graduate Coordinator Email Thesis/Dissertation Advisor

EMAIL GRADUATE COORDINATOR OF DEGREE PROGRAM

EMAIL THESIS/DISSERTATION ADVISOR

GRADUATE SCHOOL APPROVAL

GRADUATE SCHOOL DECISION*

APPROVED DENIED

Denial Reason*

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