Document 6527037

 SAMPLE
Senior Freshman Essay Submission Form
Student Name:
A. N. Other
Student ID Number:
10234567
Programme Title:
Single Honors
HPS
TSM
Erasmus
Visiting Student
European Studies
Single Honors
Module Code
Module Title
HI2100
Europe, C.1215-1517: Religion, Death and Culture
Essay Title:
Did anyone benefit from the Black Death?
Lecturer(s):
Dr D Ditchburn
Date Submitted: 14 November 2011
I have read and I understand the plagiarism provisions in the General Regulations of the
University Calendar, contained on pages H18 and H19, and found at:
http://www.tcd.ie/calendar/assets/pdf/tcd-calendar-h-regulations.pdf.
I declare that the assignment being submitted represents my own work and has not been
taken from the work of others save where appropriately referenced in the body of the
assignment.
I have emailed a copy to sfhistes@tcd.ie
Signed:
Anne N. Other
Date: 14 November 2011