Research Carrel Application Form

Print:

Name (Last, First, MI): ___________________________________________________

Banner ID#: ____________________

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

Email:_____________________________________________________________________________________

Address: ______________________________________________________________________________

___________________________________________________________________________________

Department: _____________________________________ Status: ___PhD ___Masters ___Other

Semester / Session: _____ Fall _____ Spring _____Summer

If less than a semester: ______________________ to ________________________

Floor Preferred: _____2 nd _____3 rd _____4 th

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

 

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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: