PLU Thesis Reimbursement Application

Name (print): _____________________________________________________

Advisor (print): ____________________________________________________

Number of thesis copies bound: ____________________

Date of final defense: ____/____/____

Address for delivery of reimbursement check:

Please answer the following questions truthfully (failure to apply accurately and truthfully may result in a loss of priviledge to apply for PLU funds for you and your research group):

Are you a member of PLU? Y/N

If yes, do you consider yourself an active member? Y/N

If no, do you consider yourself an active member of the department? Y/N

Have you ever received PLU travel money? Y/N

If yes, please indicate the date and the meeting you attended.

Do you currently have a fellowship? Y/N

Does your group currently have grant money? Y/N

Do you have any other source of funding to pay for thesis printing? Y/N

If yes, please indicate the source.

IMPORTANT!! Please attach an itemized list of expenses and relevant corresponding receipts (receipts must be clearly marked as described in guidelines.) Ambiguous receipts will be ignored.

Student Signature: ________________________________ Date: ____/____/____

•Signature attests that the information above is accurate to the best of your knowledge.

Advisor Signature: _______________________________ Date: ____/____/____

•Signature attests that the information above is correct to the best of your knowledge.

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Official Use Only

Rec'd: ____/____/____

By: ___________________________________

Amount: ________________

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Thesis Copying Aid Request Form

Name (print): ______________________________________________________

Advisor (print): _____________________________________________________

Number of pages in original: __________

Number of copies to be made: __________

Date copies needed: ____/____/____

Type of Thesis copies: Preliminary     Final

Are you a member of PLU? Y/N

If yes, do you consider yourself an active member? Y/N

Other requests: (check all that apply)

• Use special paper (must be supplied by the student) __________
• 3 hole punch __________
• One side __________
• Both sides __________
• Other (specify) __________

Attention non-PLU members

There will be a charge of $0.03 per page copied. PLU retains the right to withhold copies of the thesis until payment is made in full.

Signature: ______________________________________ Date: ____/____/____

•Signature attests that the information above is correct to the best of your knowledge.

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Official Use Only

Rec'd: ____/____/____

By: __________________

Charge: ______________

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