Copyrighted Material Use Permissions Request Form
Your Name
Organization / Affiliation
Email
Phone
Title/Description of Material Requested
Creator/Author/Source
Details of Material (e.g., page numbers, image numbers, description)
Intended Use (e.g., education, publication, presentation)
How will the material be distributed?
Format (e.g., print, digital)
Expected Audience Size
Additional Information or Requests