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Coursepack Permission Agreement
________________________________________
("Licensor")
________________________________________ ("User")
Department: ________________________________________
School Name: ________________________________________
Course name and number: ________________________________________
( "the Course").
Date when Course starts:
________________________________________ (the "Course date").
Authorization
Licensor authorizes User to photocopy the Selection, as
defined below, for purposes of creating a photocopy anthology (the
"Coursepack") for sale or distribution to students and academic
customers in the Course.
Number of Copies & Assembly
_______ copies of the Coursepack shall be assembled and
distributed for the Course:
___ by User
___ by on-campus bookstores or copy centers, or
___ by off-campus copy shops.
Number of pages (or actual page numbers) to be used
________________________________________.
The permission granted in this Agreement is limited to the
Course and institution listed above and to be used for one semester only.
Any further rights must be negotiated separately.
Material for Which Permission Is Sought
Title of text or artwork:
________________________________________ (the "Selection").
Author: ________________________________________.
Source publication (or product from which it came):
________________________________________.
If from a periodical, the ISSN, volume, issue and date. If
from a book, the ISBN: ______________________.
If from the Internet, the entire URL address:
________________________________________.
Credit
A standard credit line including User's name will appear
where the Selection is used. If you have a special credit line you would
prefer, indicate it here: ________________________________________.
Fee
User shall pay a fee of $_______ to Licensor at the
following address: ________________________________
________________________________________ within 30 days of
commencement date, listed above.
Warranty
Licensor warrants that it is the owner of rights for the
Selection and has the right to grant the permission to republish the
materials as specified above.
________________________________________ (User signature)
Name: ________________________________________
Title: ________________________________________
Address: ________________________________________
Date: ________________________________________
Permission Granted
By:________________________________________
________________________________________ (Licensor
signature)
Name: ________________________________________
Title: ________________________________________
Address: ________________________________________
Date: ________________________________________
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