Application for Permission to Publish Materials
Oregon State University Libraries Special Collections & Archives Research Center
Date of Request
Applicant Information
Name of Applicant
Institution/Occupation
Institutional Status:
☐ Non-profit
☐ Commercial
☐ Not for Profit
☐ Commercial
☐ Not for Profit
Mailing Address
Phone Number
E-Mail Address
Publication Information
Publication Title
Publisher
Publisher Status:
☐ Non-profit
Publication
Format
☐ Newspaper/Magazine/Journal Article
☐ Book/Textbook
☐ Television
☐ Film
☐ Audio recording
☐ Web
☐ Alternative Digital Form (please specify):
Anticipated Date of Publication
☐ Other (please specify):
Additional Comments
Items to Publish
ID Number
Description of Item
Terms of Permission to Publish
Oregon State University Libraries Special Collections & Archives Research Center
1.
Applicant requests permission to publish item(s) from the Oregon State University Libraries Special Collections & Archives Research Center
(hereinafter SCARC). List items individually with identification number on the reverse.
2. Applicant agrees not to display, perform, modify, reproduce, or publish the above-identified item(s), or any other material from SCARC, except as
expressly set forth above, or as otherwise expressly permitted in a written document signed by an authorized representative of SCARC.
3. Applicant agrees that the permission, if granted, is for a one-time use only for a first edition of the work published. Applicant agrees, at no
further charge, and assuming permission is granted, to donate (1) copy of the work upon its completion to SCARC, with OSU having right to lend
or otherwise distribute the copy in the same manner as permitted under United States Copyright law for any other work of authorship.
4. Applicant understand and agrees that, if permission is granted, it is granted for a period of two years, only, measured from the date of the
signature by an authorized representative of Oregon State university Special Collections, below.
5. Any of the above item(s), if included in the work, shall be identified with the following credit line: “From the [Collection Title], Special Collections
& Archives Research Center, Oregon State University” at the location of the item(s) in the work. If the item(s) are reproduced in a book, in
addition, the following credit line shall be included on the copyright notice page of the book (or the back of the title page, if no copyright notice
page exists): “Selected item(s) found in this book are from the [Collection Title], Special Collections & Archives Research Center, Oregon State
University”.
6. Applicant understands and acknowledges that Oregon State University may own the tangible item(s) described above, but may not own the
copyright rights to such item(s). If the item(s) are copyrighted, and the copyrights are owned by an entity other than OSU, or the item(s) are
subject of other protection under the law, Applicant acknowledges that it is Applicant’s responsibility to secure permission from the holder of the
copyright or other rights before the item(s) are published.
7. Applicant acknowledges and agrees that SCARC does not assume any responsibility for copyright infringement or other violations of anyone
party’s rights relating to Applicants obtaining a copy of or use of the item(s) regardless of whether SCARC provides Applicant with a copy of the
item(s). OSU makes no representation or warranty that it holds the copyrights or other rights of any other parties. Applicant hereby agrees to
indemnify, defend, and hold harmless the State of Oregon, the Oregon State Board of Higher Education, Oregon State University, and their
officers, employees, and agents from any such claims.
8. Applicant agrees not to change any copyright notes or legends found on the materials obtained from OSU.
9. Applicant agrees to submit this form in duplicated, with each being in full effect as an original, if fully executed, along with the payment of the
requisite fee (Vie Fee Schedule) to SCARC. Permission is not granted unless and until a copy of this form is returned to Applicant bearing the
signature of an authorized representative of SCARC.
10. Applicant acknowledges and understands that OSU is not required to grant permission to Applicant and that, in absence of a signature by an
authorized representative of SCARC, that the permission is denied. OSU will refund the fee to Applicant in the event permission is denied.
Applicant
Date
OSU SCARC Staff Member
Date
The completed form should be returned to:
The Special Collections & Archives Research Center
The Valley Library, Oregon State University
Corvallis, OR 97331-4501
Phone: (541) 737-2075 Fax: (541) 737-8674 Email: scarc@oregonstate.edu