Student Name: _____________________________
Local Address: _____________________________
Local Phone: ______________________________
E-mail address: ____________________________
Paper Title: _______________________________
Student Signature: __________________________
For the Course Instructor:
Course Name: ______________________________
Course Number: ____________________________
Section Number: ____________________________
Instructor: _________________________________
Instructor's Signature: ________________________
For office use only: Submission Date: _____________ Time: __________