Copyright Permissions Request Form
To request permission to reprint copyright protected material, complete as much of this form as you can and submit it to the Librarian
Email ( if not NU):
or Campus Ext.
Number of Students:
How will the material be used?
Photocopy for course packs or classroom handouts
*Photocopy for coursepacks or classroom handouts
*Posting on course management systems (e.g.,Blackboard), e-coursepacks
Orginal Source: Book
Title of original source:
ISBN/ISSN (if available)
Title of article (periodical )/chapter title or number(book)
Vol., issue, date of article or date of book:
Number of Copies:
Do Not Fill This Out