Attachment 6

Internet Publication of Doctoral Thesis Confirmation FormMonth:

11 Day: 18 ,Year2024

To: The Dean of the Graduate School of Medicine, Nagoya University
Degree Classification
Scheduled Degree
Award Date

By Thesis

School・departmentFebruary, 28,2025

Name

Medical science・Integrated Medicine〇〇〇〇 〇〇〇〇☐ {Full-text publication}

I hereby acknowledge that internet publication of my doctoral thesis (full text) submitted to the University will cause no problems, andthus agree to have it published on the internet. (Note: If your publisher, etc. imposes any specific conditions on full-text internetpublication, such as format modification, submit documents detailing such conditions.)☐ {Withhold full-text publication} * subject to internet publication of a summary during the withholding period

I hereby request to have my doctoral thesis (full text) submitted to the University withheld from internet publication, based on thefollowing reasons/circumstances, and to have a summary of my thesis published instead during the withholding period. I will, without fail,submit the designated form (Form: Attachment 7) associated with the resolution of the following reasons/circumstances, unless my thesis
is to be automatically subject to internet publication.
Submission Period of theTypes

Reasons/Circumstances"Form: Attachment 7"☐ Published: Under the publisher's copyright policies, internet publication will
not be permitted until (Month:Day:,Year:).
☐ BookPublication☐ Scheduled to be published: (Month:,Year:).
Under the publisher's copyright policies, internet publication will not be permitted
Day:,Year:).
until (Month:☐ Scheduled to be published: (Month:,Year:
The publisher's copyright policies cannot be confirmed.

).

☐ Published: Under the publisher's copyright policies, internet publication
Day:,Year:).
will not be permitted until (Month:☐ AcademicJournalPublication☐ Scheduled to be published: (Month:,Year:).
Under the publisher's copyright policies, internet publication will not be permitted
Day:,Year:).
until (Month:☐ Scheduled to be published: (Month:,Year:
The publisher's copyright policies cannot be confirmed.

☐ PatentApplication,Utility ModelApplication☐ Other).

☐ Patent application to be filed/being examined (application not published yet)Time of filing (scheduled): (Month:,Year:).
☐ Utility model application to be filed/being examined
Time of filing (scheduled): (Month:,Year:).
(Provide concrete, specific reasons/circumstances)

Not required: Subject toautomatic internet publication
Date of internet publication
permitted under the publisher's
copyright policies(ASAP from the above date)
Scheduled date of or date ofbook publication(ASAP from the above date)
Not required: Subject
to automatic internet publication
Date of internet publication
permitted under the publisher's
copyright policies(ASAP from the above date)
Scheduled date of or date ofjournal publication(ASAP from the above date)
Date of application published(ASAP from the above date)
Date of application registered(ASAP from the above date)
Date of resolution ofreasons/circumstances☑ {Summary publication} (in the case where full-text internet publication is impossible)

I hereby request to have my doctoral thesis (full text) submitted to the University NOT published on the internet, based on the following
reasons/circumstances, and will have a summary of my thesis published instead.
(Provide concrete, specific reasons/circumstances)
My thesis being subject to book or academic journal publication, full-text internet publication will not be permitted under the publisher's copyrightpolicies.

(Examples) - My thesis being subject to book or academic journal publication, full-text internet publication will not be permitted under
the publisher's copyright policies. (Note: If this applies to you, you must submit documents specifying the publisher's copyright policies.)-Internet publication is impossible because my thesis contains physical 3D works.
- My thesis contains confidential information. / Internet publication may cause serious harm, in terms of confidentiality※Please refer to the instruction on the back when filling out the form.

How to fill out “Internet Publication of Doctoral Thesis Confirmation Form”
With regard to internet publication of the full text of your doctoral thesis after the degree
is awarded, check one [ ] from options {Full-text publication}, {Withhold full-textpublication} and {Summary publication} (in the case where full-text internet publication
is impossible) on the back of this form, and submit along with your application for adoctoral degree.
< Important Notes >1) If the Graduate School responsible for your thesis review regards the reasons forwithholding your thesis from internet publication as unavoidable, a summary of yourdoctoral thesis, instead of the full text, will be published via the NAGOYA Repository(Nagoya University Academic Repository).
In the case of restricted internet publication due to book or academic journal
publication of your thesis, the full text of your thesis will be published after the
restriction period has lapsed.
2) Even if the full text of your doctoral thesis will not be published on the internet,
whether at all or for a certain period of time, your thesis will be subject to viewing bythe public.
Nagoya University will provide viewing of doctoral theses in an electronic format
through the counter services of the University Library (Central Library on theHigashiyama Campus). Viewing of doctoral theses will be also provided at theNational Diet Library.
3) If copyright-related procedures are required for internet publication due to book oracademic journal publication of a thesis, the author will be responsible for managing
the appropriate procedures.