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Research Carrel Application Form

Print:

Name (Last, First, MI): ___________________________________________________

Student ID#:____________________


Phone: (Cell)________________ (Home)__________________ (Office)_____________________


Email:_____________________________________________________________________________


Address:___________________________________________________________________________


__________________________________________________________________________________


Department:_____________________________________ Status: ___PhD ___Masters

Semester / Session: _____ Fall _____ Spring _____Summer

If less than a semester: ______________________ to ________________________

Floor Preferred: _____2nd _____3rd _____4th

Explain the reason you will need a Research Carrel for the time period stated above:

 

 

 

_____ I have read and agreed to the Research Carrel Policies and Procedures.



Applicant’s Signature:_______________________________________

Date:_______________________


Department Chair’s Assessment:

___ The PhD candidate’s dissertation has been approved.

___ I support the graduate candidate’s application & verify the research project is accurate.


Department Chair’s Signature: ____________________________________
Date: _______________


Print Name: _______________________________ Email: ___________________

For Office Use:

Priority: __________ Date Received: __________ Assigned Room No.: __________

Comments:

 

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