Copyright Permission Request Form

Thank you for requesting a limited copyright release from Committee for Children. Please answer the following questions so we can make an informed response to your request. Please allow at least five business days for us to respond to your request.

(* Required)
Name *
Job Title *
School/Organization *
Address *
City, State and Zip Code *
Telephone *
FAX
Email Address *
I am requesting a release for material from the following program: *

Copyright Date of Material
Level of Program

Type of Material *

If this material is a paper document, the location/source of the material is:

The page number(s) of the material is/are:
If this material is a Web document, the exact URL is:
The exact title of the material is: *
The number of copies you wish to make and distribute is: *
In what geographic area, and through what particular organization (e.g., name of school, school district, county, publication, etc.)?
What is your intended purpose for reproducing or distributing the material (e.g., teacher training, parent outreach, student awareness, master’s/doctoral work, research study, etc.)?
Over what period of time do you wish to distribute the material?
Do you wish to translate this material into another language? If so, what language? *
Additional Comments


Committee for Children

Copyright and Permissions

Copyright Permission Request Form