Fill out one form for EACH article/excerpt photocopy which you are requesting for course reserve. Instructor must sign and date the form on the bottom line.
I.
Course #:
Course Name:
Semester/Year:
Instructor's Name:
Department:
Office phone #:
II. Book Excerpts: please supply the following information:
Author:
Title:
Journal articles: please supply the following information:
Journal title:
Date:
Article title and page numbers:
III. Compliance with "Fair Use" guidlines:
Is this work protected by copyright? If so, to be placed on course reserve it must either fall within fair use guidelines, or permission must be granted by the copyright holder. CHECK ONE.
____ This work is covered by copyright, and I have not placed a copy of this work on reserve for this course previously, and the photocopy comprises less than 10% of the work.
____ Permission has been granted by the copyright holder to place this material on reserve this semester. A copy of copyright permission is attached.
____ There is no notice of copyright in the original work, and it was published on or later than January 1, 1978.
IV.
Instructor's signature:
Date:
Printed name:
Last updated: April 17, 2007.