Thesis/Dissertation Co-Author Contribution Disclosure Form

Student Name Thesis/Dissertation Title Degree Program Advisor/Supervisor Name Date

Co-Author Details & Contributions

Co-Author Name Affiliation Section/Chapter Involved Contribution Description
Additional Comments (if any)

Declarations

I hereby declare the above contributions are accurately represented and all co-authors have been informed.
Student Signature
Date
Advisor/Supervisor Signature
Date