Form to Request Copyright Permission - Book Excerpts

See instructions for filling out copyright request forms


Instructor:
Course #:

Title of book:


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

Chapter title:

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

Year/Edition: ISBN:      
Pages:            Publisher:

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: