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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: Mailing 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 Step® Elementary Classroom KitsSecond Step® Elementary Digital ProgramSecond Step® Middle School Classroom KitsSecond Step® Middle School Digital ProgramSecond Step® Out-of-School TimeSecond Step® SEL for AdultsSecond Step® Bullying Prevention UnitSecond Step® Child Protection UnitMind Yeti®ParkPals: 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? 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Reason for copyright permission request: If you are requesting permission for a research study or project, please provide the name of the university and be prepared to provide a letter from the university advisor overseeing the study or project.