Assignment Submission Form

Student Name:

Programme: BMus

Year:

Principal Study:

Module title:

Module teacher:

Title of assignment:

Deadline for Submission: Tuesday 14th May 2013, 5.00pm

I declare that the assignment submitted is my own work and has not (either in whole or in part) been submitted towards the award of any other qualification for the Academy or elsewhere. I have referenced all sources of information used during the completion of the assignment and understand that if I am found guilty of any form of academic malpractice the matter will be referred to the Academic Malpractice Committee who will impose an appropriate penalty (see Academic Malpractice Regulations).

Signed:

Date:

Staff initials:

Receipt to be completed and retained by student as proof of submission. Please keep this receipt safe as it is the only proof that your work has been received.

Surname Forename

Title of Course

Signature Date

Staff Initials