ICPSR UNDERGRADUATE RESEARCH PAPER ENTRY AND PUBLICATION

RELEASE FORM
2017

Entry must be a research paper from undergraduate student(s) analyzing any topic
using data from the ICPSR General Archive
(http://staging.icpsr.umich.edu/icpsrweb/ICPSR/index.jsp) or Thematic Collections
(http://staging.icpsr.umich.edu/icpsrweb/content/membership/partners/archives.htm
l).
Entrants must be from ICPSR member institutions; entrants may be from the
US or outside the US.

Please fill in all information below electronically. Incomplete application

forms will be ineligible for entry into the competition. Thank you and good
luck!

Instructions for Submission

1 This form can be filled out electronically and saved to your desktop. Please
complete all information and save the file using the following file-naming
scheme:
ICPSR Undergraduate Competition - LAST NAME
This naming scheme will be used for the entry, paper, and email subject line.
2 With the exception of the information that you enter, do not edit the content of
the entry form. Entry forms that have been edited will invalidate the submission
package.
3 This completed file must be submitted along with the research paper using the
naming scheme as described in instruction point #1 for the paper, e.g.:
ICPSR Undergraduate Competition - LAST NAME_Paper.Doc
and for the entry form:
ICPSR Undergraduate Competition - LAST NAME_Entry.Doc
in ONE email that arrives at ICPSR no later than 12:00 a.m. (midnight) PST on
January 31, 2017.
4 Paper format. The research paper and entry must be in MSWord or Adobe
Acrobat (PDF) format.
5 Both files must be attached in the single email submitted to
undergradpaper@icpsr.umich.edu. You must copy the advisor or mentor
listed in this document and any co-authors listed on page 4 of this
document for the entry to be considered complete.
6 Subject Line: Email submissions must include the title as described in
instruction point #1:
ICPSR Undergraduate Competition - LAST NAME in the Subject Line.
7 Please contact Dory Knight-Ingram at dkni@umich.edu with any other questions
about the competitions.

Instructions for Co-authored Papers

Page 1 of 7
1 Research papers with multiple authors must include the full legal names, email
addresses, and expected graduation dates of each author in the space provided
below.
2 Inclusion of the names and email addresses are verification of the co-authors
agreement to the Statement of Original Work, Undergraduate Status, and
Authorization to Publish.

3 None of the co-authors may have graduated with a bachelors degree before
April 1, 2016.

4 All co-authors must be copied on the submission email (in addition to

the advisor/mentor) for the application to be considered complete.

Date of Submission:_________________________________

Lead Author Contact Information

Student/Author Name: ( Mr., Ms., or Mrs. Please check one.)
_____________________________________________________________________________________

Email Address:___________________________________

School
Affiliation:_______________________________________________________________________

Title of
Paper:_________________________________________________________________________

Mailing Address Permanent Address

Street Address____________________________ Street
Address_____________________________

City_____________________________________ City______________________________________

State/Province____________________________
State/Province_____________________________

ZIP/Postal Code___________________________ ZIP/Postal

Code_____________________________

Phone___________________________________ Phone____________________________________

Student Profile
Classification: Freshman Sophomore Junior Senior
Recent Grad

(Expected) graduation date: __________________ (Expected) degree:__________

Page 2 of 7
Major(s):__________________________________ Minor(s), if any:
______________________________

Racial Ethnic Background (select all that apply)

Black/African American White American Indian/Alaskan Native
Asian

Hispanic Descent Other Native Hawaiian/Pacific

Islander Decline

Author Information
I am the sole author of the paper

This paper has multiple authors (List names on Page 4)

Page 3 of 7
ICPSR Study Information
Please provide information about the ICPSR dataset(s) used in your research paper:

ICPSR Study
Title(s):_____________________________________________________________________

ICPSR Study Number(s):________________________________

ICPSR Dataset Number(s):______________________________

Academic Advisor/Mentor
Name:______________________________________________________________________________
__

Title:________________________________________________________________________________
_

Department:________________________________________________________________________
__

Mailing
Address:_______________________________________________________________________

Phone:_________________________________

Email:________________________________________________

Statement of Original Work, Undergraduate Status, and Authorization to

Publish

The paper submitted within this entry is an original work developed and presented
by the author(s) listed within the entry form. All sources used to develop this paper
have been properly credited and cited. The paper submitted was produced while I
(and any other author(s), if applicable) was an undergraduate affiliated with an
ICPSR member institution.
In addition, I herewith authorize ICPSR to publish the above paper in its Bulletin
and/or on its website. This paper has not been published previously nor has it been
copyrighted elsewhere.
The inclusion of my full legal name and email address below constitutes my
electronic signature and is verification of my agreement to the statements above.
Author Full Legal
Name:_________________________________________________________________
Author Email Address:_____________________________________

Page 4 of 7
Date:__________________________

Page 5 of 7
Co-Author Statement Agreement and Contact Information
The paper submitted within this entry is an original work developed and presented
by the author(s) listed within the entry form. All sources used to develop this paper
have been properly credited and cited. The paper submitted was produced while
the other author(s) and I were undergraduates affiliated with an ICPSR member
institution.
In addition, I herewith authorize ICPSR to publish the above paper in its Bulletin
and/or on its website. This paper has not been published previously nor has it been
copyrighted elsewhere.
The inclusion of my full legal name and email address below constitutes my
electronic signature and is verification of my agreement to the statements above.

Co-author full legal

name:________________________________________________________________
Co-author email address:_____________________________________
(Expected) graduation date (month/year):____________________

Co-author full legal

name:________________________________________________________________
Co-author email address:_____________________________________
(Expected) graduation date (month/year):____________________

Co-author full legal

name:________________________________________________________________
Co-author email address:_____________________________________
(Expected) graduation date (month/year):____________________

Co-author full legal

name:________________________________________________________________
Co-author email address:_____________________________________
(Expected) graduation date (month/year):____________________

Co-author full legal

name:________________________________________________________________
Co-author email address:______________________________________
(Expected) graduation date (month/year):____________________

Page 6 of 7
Page 7 of 7