Application to exclude use of the doctoral thesis (embargo)
PhD / Doctor of Philosophy (Q 794 440 202)
Clinical PhD / Doctor of Philosophy (Q 794 445 202)
Please complete this form exclusivly computer based and tick where appropriate!
Department of International Relations - PhD School
Fritz-Pregl-Straße 3, 4.Stock 6020 Innsbruck, Austria Tel. +43 512 9003 - 70050
PhD-Studien@i-med.ac.at www.i-med.ac.at
Applicant
Academic degree, surname:
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First name:
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Registration number:
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Address:
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Phone number:
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Information and reason to exclude use of doctoral thesis
Title of thesis:
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Time of the embargo after submission of the doctoral thesis (years, max. 5):
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Reasons for embargo: (Substantiation that important judicial or economical interests of the applicant are endangered; add appendix if necessary):
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Date Student's signature
Agreement of Vice Rector for Teaching and Study Matters
Embargo of doctoral thesis will be
accepted not accepted
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Date Vice Rector for Teaching and Study Matters
ao. Univ.-Prof. Dr. med. univ. Wolfgang Prodinger, MME (Bern) 2/2
