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Copyright Permission Service form

Please complete the following form if you require permission from a copyright owner to use their material in any teaching, learning or research activity in your capacity as a La Trobe University staff member, or as a Graduate Research student for use in a thesis, research project or published paper.

Please provide accurate information to ensure your request is handled promptly.
For assistance or more information please email copyright@latrobe.edu.au

Personal Details

Requestor's name *

Requestor's organisation/department *

Email Address * Students: studentID@students.latrobe.edu.au (Example: 12345678@students.latrobe.edu.au) or Staff: staffid@latrobe.edu.au (Example: j.blogs@latrobe.edu.au)

Contact number

What kind of work is the material? For example: journal article, song, photograph, etc

Full citation of the material you want to use All details you have, such as: title; author/creator/director; publisher; date; ISSN/ISBN and pages for print works etc.

How much of the material do you want to use? E.g. page range for print publications

Full item or a certain section? If a certain section, please specify.

Organisation that owns copyright in the material Include contact details

Source or location of the material you want to use If online, please provide URL

Please give a detailed description of what the material will be used for. I.e. In a course of study, for internal staff use; as an academic commercial publication etc.

Please give a detailed description of where you would like to reproduce the material. I.e. on a learning management system; in a book; on a web site etc.

How many copies do you want to make of the material?

Please indicate how long you will intend to use the material for. I.e. for one semester, indefinitely, etc.

Please indicate if you wish to adapt, modify or change the requested material in any way?

What date do you need to receive the permission by? *

Day Month Year

Information on this page adapted from University of Melbourne Copyright Office and used with permission from University of Melbourne

Validation

Confidentiality

All information provided by applicants will be treated as confidential. At La Trobe University, we respect the privacy of your personal information. We collect personal information in your submission to aid in determining the legitimacy of your copyright claim. In accordance with privacy laws, personal information about you contained in your submission will not be used for any other purpose or disclosed to any person who is not part of the investigation. You may have the right to access personal information we hold about you, subject to any exceptions in relevant laws, by contacting the University Copyright Advisor on 9479 5360. The La Trobe University privacy policy can be viewed at: www.latrobe.edu.au/privacy/