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EGAAA Copyright Permission Form - Exhibit 3

Adopted:May 18, 1989
Ammended: May 9, 2006



School:

Teacher:

Address:

Permission is requested to reproduce the following copyrighted material(s):

Title of work:   

Author(s):

Publisher:

© Date:

Edition:

ISBN:

Page No (s):

Other:

Total Number of Photocopies to be Made:

 

Date Required:

Duration of Permission:

Format Modification/Translation   

Language

Braille

Audiotape

Large Print

Excerpts or Adaptation (see attachment)

Other

Use of Materials 

Classroom Use (specify)

Course:

    

Special Circumstances (e.g., class newsletter, etc.)

Copyright Owner

Permission is hereby granted to __________________ of ____________________ school to photocopy the material as specified above.

Credit Statement:

______________________________________________________________________

Under the Following Conditions:

________________________________________________________

Authorized by:

_______________________________________

Position:

__________________

Company:

_______________________________________

Date:

__________________


References

Legal Reference:

Family Law Act - Section 20 & 21

     

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