University of Illinois at Springfield
Liberal Studies Program
Student Paper
Copyright Permission Form
U.S. Copyright Law (17 USC, section 106) prohibits the copying or use of a work, including
student papers or projects, without the authors’ permission. Before making a copy of a student’s
work available to other students, this form must be filled out and submitted to the Liberal
Studies Program. A copy of this document will be placed in the student’s file.
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I hereby give permission for my paper/project to be used as an example by the US Program of
UIS in either paper or electronic form. I understand that as much personal information as
possible will be redacted from the paper/project. This permission will remain in effect unless
revoked by the student. All requests to terminate this permission must be in writing.
Name of Paper or Project:
Name of Student:
Signature: Signature Waived If Submitted Online
Date:
If a paper/project has more than one author, a permission form is required for each person.
Please submit the form to:
University of Illinois at Springfield
Liberal Studies Program, UH 3038
One University Plaza
Springfield, IL 62794-5407
Or email to the person requesting permission
If submitting this document in person, omit “Signature Waived If Submitted Online” on the signature
line, print this page, and sign it. Otherwise, fill in the text and a copy of the email will be attached to this
document as proof of permission.
LIS GA 10/07