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 [email protected] Signed: Anne N. Other Date: 14 November 2011
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