Form to Request Copyright Permission - Clips From Videos/Films

See instructions for filling out copyright request forms


Instructor:
 Course #:

Title of video/film:


Studio/Movie company:

Length of clip:
 		Length of film:

Time sequence of clip within film:

Description of scene in clip:

Intended use of 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: