One to One Application

1. To be filled in by Student

Name:_______________________________________________________________

Address:_____________________________________________________________

Phone:_______________________________________________________________

Major Field:__________________________________________________________

E-mail:______________________________________________________________

2. To be filled in by Faculty Advisor

Name:_______________________________________________________________

Phone:_______________________________________________________________

I certify that this student is enrolled in the doctoral program or engaged in their master’s thesis research.

Signed:______________________________________________________________

To enroll in the “One to One” program offering individualized assistance with research, complete this form and mail or bring to the User Services Division, Newton Gresham Library, Sam Houston State University, Huntsville, Texas 77341-2179

Note: SHSU faculty who are working on a dissertation may enroll by completing Part A only.

No person shall be excluded from participation in, denied the benefits of, or be subject to discrimination under, any programs or activity sponsored or conducted by Sam Houston State University on any basis prohibited by applicable law, including, but not limited to, race, color,

national origin, religion, sex, or handicap.