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Permission to Reprint Form - Publications

Please provide as much information as possible in the form below.

This form is designed for authors and publishers seeking permission for forthcoming publications. If you are requesting permission for photocopying, online posting, or other informal publication, please use this form.

• Requestor Information

• Name*FirstLast
• University/Company*
• Department
• Address*
  Street AddressAddress Line 2CityState / Province / RegionPostal / Zip Code
• Phone Number*###-###-####
• Email*

• Stenhouse Material Requested

• Title*
• Author(s)*
• Detailed Description of Material
  (ex. Chapter 5; pp. 89-94, text only Figure 2.4)*
• Publication Year

• Intended Use

• Format (Check all that apply)*
  Print BookDVD/VideoWebsite/ElectronicAudio RecordingeBookOther
• Rights Sought*
  US/CanadaWorldOther
• Title*
• Author's Name*FirstLast
• Publisher*
• If non-profit organization, 501(c)3 Number
• Estimated Page Count*
• Estimated Publication Date*
• Estimated First Run*
• Estimated Retail Price*
• Additional Comments

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