Form to Request Copyright Permission - Articles

See instructions for filling out copyright request forms

Instructor:
Course #:

Title of periodical:


Volume:
Issue #:
Pages:
Date:

Article title:

Author(s) [please include first and last name(s)]:

If this selection is excerpted from an anthology, state the title of anthology and year:

If material is taken from a web site, state the complete web site name and address:

I am asking for (select one):
photocopy rights      electronic rights

If used at web site, state URL:

If used at web site, is the site password protected?  Yes      No

If you would like a copy of this form enter e-mail address: