Copyright Certification Form
Certification Regarding Instructional Use of Copyrighted Material in Library Reserves
WARNING CONCERNING COPYRIGHT RESTRICTIONS: The copyright law of the United States (Title 17, United States Code) governs the making of photocopies or other reproductions of copyrighted material. Under conditions specified in the law, libraries and archives are authorized to furnish a photocopy or other reproduction. One of these specified conditions is the photocopy or reproduction is not to be “used for any purpose other than private study, scholarship, or research.” If a user makes a request for, or later uses, a photocopy or reproduction for purposes in excess of
“fair use”, that user may be liable for copyright infringement.
Instructor’s Name: __________________________________________
Department: _______________________________________________
Course Title and Number: ____________________________________
Semester/Year: _____________________________________________
Material to be reproduced:
Author: ____________________________________________________
Title of article or chapter: ______________________________________
Title of periodical or other source: ________________________________
Volume: ____ Number: _____ Year: _____ Pages: ____
Certification of compliance with copyright law :
This agreement is to protect Curry Library, William Jewell College and the faculty concerning reproduction of copyrighted material. By signing this form, the faculty member accepts legal responsibility for the reproduced material.
RELEASE WAIVER: I, _______________________________ (faculty member), state that I have been provided access to a copy of the minimum standard under Section 107 of the Copyright Revision Bill concerning “fair use” laws.
I, ________________________________________ certify that (check all that apply)
___ The photocopied material submitted with this form falls within “fair use” guidelines or is not copyrighted.
___ I understand that I will not be able to use these materials again without first obtaining permission from the copyright holder.
___ I have obtained prior permission from the respective copyright holder(s), and have attached a copy of the permission statement(s).
___ The students are not assessed any fee beyond the actual cost of the photocopying.
FACULTY MEMBER SIGNATURE: _____________________________DATE: _____