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Interactive
Michigan Technological University
Off Campus Graduate Degree Program Liability Statement
Michigan Technological University (“Michigan Tech”) graduate students pursuing degrees under an offcampus degree program agreement must execute this form prior to the start of their degree program.
Graduate student _____________________________________ (insert student’s name here)
is enrolled in a Michigan Tech’s off-campus MS/PhD (circle one) program in
______________________________________(insert name of academic program here)
offered through an agreement between Michigan Tech; and
______________________________________(insert name of other institution here).
As a part of the off-campus degree program each party identified above (the student, Michigan Tech,
other institution) agrees to remain liable for all risks of personal or bodily injury and property damage
caused by the negligent or willful acts or omissions of that party but subject to and reserving all
applicable immunities granted by law or constitution to any of the parties. This clause is solely for the
benefit of the parties to this agreement and is not intended to create any rights in any third party.
Signatures:
______________________________________(insert printed or typed name of Michigan Tech provost and vice
president for academic affairs here)
______________________________________( signature)
______________________________________(title)
______________________________________(date)
______________________________________(insert printed or typed name of authorized representative of other
institution here)
______________________________________( signature)
______________________________________(title)
______________________________________(date)
______________________________________(insert printed or typed name of student here)
______________________________________( signature)
______________________________________(title)
______________________________________(date)
Last reviewed on 11/12/07 by Graduate School and Research and Sponsored Programs.