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

Personal Details
Students: (Example: or Staff: (Example:
Copyright details
For example: journal article, song, photograph, etc
All details you have, such as: title; author/creator/director; publisher; date; ISSN/ISBN and pages for print works etc.
E.g. page range for print publications
Include contact details
If online, please provide URL
I.e. In a course of study, for internal staff use; as an academic commercial publication etc.
I.e. on a learning management system; in a book; on a web site etc.
I.e. for one semester, indefinitely, etc.
What date do you need to receive the permission by? *

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




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: