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FACULTY OF ENGINEERING

COURSEWORK SUBMISSION FORM


(for work submitted at Penrhyn Road only)
IT IS YOUR RESPONSIBILITY TO ENSURE THAT ALL INFORMATION BELOW IS COMPLETED
FULLY, AND THAT THE CORRECT PERSON MARKING THE WORK IS LISTED. FAILURE TO
DO SO COULD RESULT IN YOUR WORK BEING FORWARDED TO THE INCORRECT MARKER,
OR PERHAPS NOT BEING MARKED.
PLEASE COMPLETE IN BLOCK CAPITALS
Module Code: _________________

Module Title: _______________________________________

Coursework Title: _________________________________________________________________


Lecturer Marking this work: __________________________________________________________
Deadline Date: ___________________________________________________________________

INDIVIDUAL WORK

ID No _________________

PLEASE PRINT
Family Name: _____________________________________________________________________
First Name: _______________________________________________________________________
Signature: ________________________________________________________________________
I declare that the task I have submitted for assessment is my own independent work and that all
sources used in my submission are referenced.

GROUP WORK
Group Name: _____________________________________________________________________
Work to be returned to: ______________________________________________________________
We declare that the task we have submitted for assessment is our own work and that all sources of
information are referenced.
Group Members + ID Nos.

Signature

1. __________________________________

____________________

2. __________________________________

____________________

3.__________________________________

____________________

4. __________________________________

____________________

5. __________________________________

____________________

6. __________________________________

____________________

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