Copyright Permission Request Form (Faculty Support)

Professor

Semester

Course Title

Book/Journal/Newspaper Title:

Article Title (if applicable):

• Enter n/a if not applicable.
  
  

Publisher:

Year of Publication:

Author/Editor:

Page Numbers (enter exact NUMERICAL page range. DO NOT ENTER "ALL"):

• Please separate multiple page ranges with a comma.
  
  

Volume Number (if applicable):

Date of Issue (if applicable):

• mm/dd/yyyy
  

ISBN/ISSN:

Number of Students:

• If unsure of exact number of students, enter estimate or maximum class size. Contact the Registrar's office for estimate/class size.
  
  

Your Email Address:

Confirmation

• If you would like to receive an email confirming that you have submitted this form, please provide the email address you wish to have the confirmation email sent to:
  

Validation

• 
  (Enter the characters exactly as they appear above.)