CCC Account #:  2000051293

Organization:  Kenrick-Glennon Seminary

Liaison:  Tiffany Solanke

Tel:  (314) 792-6390

Fax:  (314) 792-6500                                                       

 

 Kenrick-Glennon Seminary Copyright Clearance

Request Form

 

Your Name:  

Your E-mail or Contact Number: 

Date of Request:  ,   

Start of Term:          ,  

Course Name and Number: 

Instructor:  

Number of Sets:  

*Please e-mail Tiffany Solanke with any questions or concerns.  * Permission is granted for ONE TERM use in educational course sets.

Please select the type of permission you are requesting.

  Photocopy:                                Electronic/digital form:                I want to republish into a:

                        

 

ISBN/ISSN: 

of Material 

Publisher/Rightsholder: 

Title:  

Chapter/Article Name: 

Author of Chapter/Article:    Total # of Pages: 

Copyright Year (2 digits):   Pub. Year (if differs):    Volume:

                        Edition:   

Your I.D. or Reference #:

+25% of Work?   Out of Print?    Additional Information?  (If Yes, please type in below.)