Assessment Submission Form (Graduate)
The School’s procedures for the submission of assignments are as follows:

Submit one copy of your assignment (with this Assessment Submission Form stapled to the
front) into the Assignment Box located outside the Programme Office, Room B1.06.

Submit one copy electronically via Blackboard Assignment.

One copy to be kept on file by student.

Note that there are penalties for the late submission of assessments.
Plagiarism Declaration
By signing below I agree that:
1. I have read and fully understand the UCD School of Nursing, Midwifery & Health Systems:
Policy on Plagiarism which was available to me.
2. I recognise that a plagiarised project (in whole or in part) may be subject to the penalties as
outlined in the School of Nursing, Midwifery & Health Systems Policy on Plagiarism and the
UCD Plagiarism Statement: Plagiarism Policy and Procedures.
3. I have not previously submitted this work, or any version of it, for assessment in any other
subject in this, or any other, institution.
4. I have given my correct information on this Declaration and all details are the same as those on
my student card.
5. I have read and understand the UCD School of Nursing, Midwifery & Health Systems:
Referencing Guidelines: 2012-2013 and have used the appropriate citation index.
Programme Title:___________________________________________
Programme Coordinator: ___________________________________
Module Coordinator:______________________________
Module Title: ____________________________Module Code:___________
Essay /Dissertation / Project Title__________________________________
Word limit:
Actual word count:
Student Signature: __________________
Full Name PRINT:
Student No.: ____________
_________________________Date: ____ /____ /____