Form to Request Copyright Permission - Clips from TV Programs

See instructions for filling out copyright request forms


Instructor:
 Course #:

Title of television program:

Studio/TV company:

Title of episode and/or number:

Length of clip:
 Length of episode:

Time sequence of clip within episode:

Description of clip's scene:

Intended use of clip in the project:

Title of project:

Purpose of project:

Synopsis of project:

Script pages:

Number of copies of project:
 Will copies be distributed or retained by instructor?:

If distributed, what is the mode of distribution?:

Countries of distribution:

Mode of instruction:

Length of time the contract needs to cover:

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