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Copyright Permission Request Form Choose Your Region: United States or CanadaAll other countries Requester's Information First Name Last Name Email address Verify Email address Phone number (ex. 555-123-4567) The best way to reach me is by: PhoneEmail School or Organization’s Information I work for (school or organization): Mailing address line 1: Address line 2: City State or Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundlandNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip/Postal Code Program Information I’m requesting permission to use material from the following program: Second StepSecond Step Middle School Program (2017)Second Step Bullying Prevention UnitSecond Step Child Protection UnitMind YetiParkPals: Kindness Rules The copyright date of this material is: Select Material Type Lesson(s)Lesson photos or imagesHandouts, homework, or family lettersAudio, mp3, or CDDVDPoster(s)SecondStep.org page or downloadSecondStep.org video, audio, or graphicOnline trainingLogoOther If this material is a web document, the exact URL is: The page number(s) of the material is/are (if applicable): The exact title of the material is: I want to: Make copiesTranslateAdaptOther For Whom What Time Period? Reason for copyright permission request: If you are requesting permission for a research study or project, please provide name of university and be prepared to provide a letter from the university advisor overseeing the study or project. 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Sandwich IslandsSpainSri LankaSudanSurinameSvalbard & Jan Mayen IslandsSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkeyTurkmenistanTurks and Caicos IslandsTuvaluU.S. Virgin IslandsU.S. Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUruguayUzbekistanVanuatuVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwe Program Information I’m requesting permission to use material from the following program: Second Step Early Learning (2011)Second Step Kindergarten (2011)Second Step Grade 1 (2011)Second Step Grade 2 (2011)Second Step Grade 3 (2011)Second Step Grade 4 (2011)Second Step Grade 5 (2011)Second Step Middle School Program (2017)Second Step Grade 6 (2008)Second Step Grade 7 (2008)Second Step Grade 8 (2008)Bullying Prevention Unit Kindergarten (2014)Bullying Prevention Unit Grade 1 (2014)Bullying Prevention Unit Grade 2 (2014)Bullying Prevention Unit Grade 3 (2014)Bullying Prevention Unit Grade 4 (2014)Bullying Prevention Unit Grade 5 (2014)Child Protection Unit Early Learning (2014)Child Protection Unit Kindergarten (2014)Child Protection Unit Grade 1 (2014)Child Protection Unit Grade 2 (2014)Child Protection Unit Grade 3 (2014)Child Protection Unit Grade 4 (2014)Child Protection Unit Grade 5 (2014)Mind YetiParkPals: Kindness Rules Online Content Please include title of white paper or research article Title/Description of content: URL Other Please include title and copyright year if known Title/Description of materials: Page number(s) or location of materials: I want to: Make copiesTranslateAdaptOther For Whom What Time Period? Reason for copyright permission request: If you are requesting permission for a research study or project, please provide name of university and be prepared to provide a letter from the university advisor overseeing the study or project.