HSWAGATA BUDDHA TOOTH RELICS PRESERVATION MUSEUM
RESEARCHER / STUDENT ACCESS REQUEST FORM
Form Code: HSW-F49
Request Number: __________________________
Date: ____ / ____ / ______
1. APPLICANT DETAILS
1.1 Full Name: ______________________________
1.2 Institution / Organization:
________________________________________
1.3 Course / Position (student, lecturer, etc.):
________________________________________
1.4 Supervisor (for students):
Name: _________________________________
Email: ________________________________
2. CONTACT
2.1 Postal Address:
________________________________________
________________________________________
2.2 Phone: _________________________________
2.3 Email: _________________________________
3. RESEARCH TOPIC
3.1 Title / Topic:
________________________________________
________________________________________
3.2 Short description of research:
________________________________________
________________________________________
3.3 Level:
[ ] Undergraduate
[ ] Master’s
[ ] PhD
[ ] Other: _____________________________
4. MATERIALS REQUESTED
(tick all that apply)
[ ] General museum information
[ ] Archive documents (non-confidential)
[ ] Photographs of relics / displays
[ ] Access to restricted relic data (by approval)
[ ] Staff interview(s)
[ ] Other: _________________________________
5. USE OF INFORMATION
5.1 Intended use:
[ ] Thesis / dissertation
[ ] Article / book
[ ] Media piece
[ ] Internal study
[ ] Other: _____________________________
5.2 I agree to:
- Respect confidentiality rules.
- Use proper citation when I use museum material.
- Share a copy of my thesis/report with the museum
if requested.
6. SIGNATURES
Applicant:
Name: ______________________________________
Signature: ___________ Date: ____/____/____
Supervisor (for students, if required):
Name: ______________________________________
Signature: ___________ Date: ____/____/____
7. MUSEUM DECISION (INTERNAL USE)
[ ] Approved
[ ] Not approved
[ ] Approved with conditions:
________________________________________
________________________________________
Approving Officer:
Name: ______________________________________
Role: ______________________________________
Signature: ___________ Date: ____/____/____
