UNIVERSITY OF CENTRAL ARKANSAS
UNDERGRADUATE SCHOLARS PROGRAM FORM
Instructions: This form is to be completed by the undergraduate scholar candidate, then signed by the student and the
thesis adviser. In addition, the student must complete the Thesis Release Form to allow the final thesis/project copy to be
placed in the UCA Archives. Submit completed copies to (1) Departmental Office and (2) the Registrar (McCastlain Hall).
Note: The form may be completed in Word, then printed for signatures; text cells will expand if need be. If the form breaks
to additional pages, be sure to submit all pages.
Due dates: (1) This form must be submitted to the Registrar by the end of the third full week of the semester in which the
student expects to graduate. (2) A copy of the thesis must be delivered to the Registrar by the end of the last week of
instruction of the semester of graduation.
Student’s Name:
ID #:
Campus Address:
Home Address
Local Phone Number:
Home Phone Number:
E-mail address:
Major:
Thesis advisor:
Thesis title:
Expected date of graduation:
Signatures:
STUDENT
DATE
THESIS ADVISOR
DATE
Revision: 5/2011
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THESIS RELEASE FORM
I hereby give and deliver to the University of Central Arkansas nonexclusive rights of ownership
over this manuscript, currently entitled
TYPE/PRINT THESIS TITLE
This right extends to any format in which this publication may appear, including but not limited
to print and electronic formats. Electronic formats include but are not limited to various
computer platforms, application data formats, and subsets of this publication.
I, as the Author, retain all other rights to my article, including the right to republish my
manuscript in other publications.
I certify that all aspects of my article which may be derivative have been properly cited, and
that in general I have not plagiarized anyone else's work. I further certify that I have proper
permission to use any cited work which is included in my article which exceeds the Fair Use
Clause of the United States Copyright Law, such as graphs or photographs borrowed from other
articles or persons.
SIGNATURE
DATE
TYPE/PRINT AUTHOR’S LEGAL NAME
TYPE/PRINT AUTHOR’S PERMANENT ADDRESS
Revision: 5/2011
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