LOYOLA COLLEGE

APPLICATION FOR PERMISSION TO REPRINT COPYRIGHTED MATERIAL
FOR EDUCATIONAL USE

 Date:  
Publisher: 
Address/FAX: 

Permission is requested to reproduce without fee the material listed below:

Author(s):   
Title:  
Title of Article, Chapter, etc.: 
ISBN/ISSN:
(ISBN - books   ISSN - magazines & journals)
Copyright Date:   Page Numbers:  
Estimated Number of Copies to be made: 
Bound with Other Information: 
Course Description (Course #): 
Instructor:  Year/Term: 

Type to reprint:  PHOTOCOPY  This material will/will not be sold.
To allow time for production, permission is needed by:

I have agreed to use this work and the number of copies specified above.

Signature of Requester:                                                                        

Please send response for this request (via quickest method) t

Loyola College
4501 North Charles Street
Baltimore, Maryland 21210-2699

Phone:  (410)                 ;  FAX:  (410)
Attn:  
   (Name & Dept. of Person Making Request)

PERMISSION GRANTED:                                             DATE:                           
   (Signature of authorized agent)
   Gratis:               Fee:               Denied:             
   Comments

:

Go to College Policy