Attachment Form 1
mm / dd / yyyy
Delegation of Authority for Online Publication of Doctoral Dissertation
To Dean of Graduate School of Engineering,
I hereby delegate the authority for online publication of my doctoral dissertation, whcih is defined in Article 9 ofDegree Regulations (MEXT Ordinance No.9, 1953) and Article 19 of Kobe University Degree Regulations, toKobe University and agree that Kobe University will publish my disseration through Kobe University Repository.
※Please fill in the blanks enclosed by a heavy line, and check the appropriate boxes.
Do not change the fomat of this file.
Blanks to be filled in.
Notes
Student number should be 8
digits with one-byte characters.

Student Numbersignaturename and signature

Name is to be handwritten, andsignature is also required.

Graduate
Name of School and
School ofDepartment
Department
Engineerin□ (Doctoral Degree Program
Students)
Type of Doctral□ (Doctoral Degree candidate who
Degree candidate
has not gone through the doctoralprogram)
Telephone Number

Write a phone number which isaccesible even after the degree
conferral.

Email Address

Write an email address which isaccessible even after the degree
conferral.

Dissertation Title

If written in a foreign
language, provide its Japanesetranslation as well.

Type of Online
Publication

When wishing summary publication
instead of full-text
publication, chech the box in
the field of "In Case ofDissertation SummaryPublication".

□ Full-Text Publication□ Summary Publication

In Case of Disseration Summary Publication
Corresponding
Application Form

□Form 1(Deferment)□Form 4(Exemption)

The detailed information ofsummary must be submitted withthe attachement form 2"Description of Dissertation
Summary".

To be filled by Academic Supervisor
Check byPlagiarism
Detection Software
Name of Adcademic
Supervisor andstamp

Please report if the disserationis checked by a plagiarism□Yes, the dissertation undergwent adetection software (ex.
plagiarism check.
iThenticate). Also please submit□No (Reason:)the report of plagiarism checkalong with this form if checked.
Please have this application
印form checked by your academic
stamp
supervisor.

【Place of Submission】
Student Affairs Section , Graduate School of Engineering（Tel.：078-803-6350
E-mail： eng-kyomugakusei@office.kobe-u.ac.jp ）※Online publication of dissertations (either full-text or summary) will not infringe rights (such as copyright)
which belong to someone else besides the applicant.

Attachment Form 2
Description of Dissertation Summary
Student Number
Name (handwritten)
Composition of Doctoral Dissertation and Type of Summary
Total number ofpages

Type of Summary

Pages
□
□

Online publication of Summary organized by the following chart
Submitting Dissertation Abstract as Summary. Acceptable only when
applying to defer full-text online publication with the form 1

Composition of Summary(In case of submitting the dissertation abstract as a summary, please write "ALL" under"Chapter Number", and write the total number of dissertation pages under the "Original
Dissertation Page".
Original
Reasons for Deferment or Exemption
Chapter Number
Type of Publicationof full-text publication
Dissertation Page～～～～～～～～
Total number of
PDF summary pages

Pages (No matter what type of summary an applicant
chooses, please write the total number of PDF
summary pages.)

Reasons for submitting the disseration abstract as a summary(Please check the appropriate box which explains the reason. If you choose the "otherreasons", describe the details.)□This is because there will obviously be no problem to do full-text online publication in
two years since the above reason will be overcome by that time.
□It is due to other reasons.

Supplemental Explanation to make a summary based on the composition above