Sample Student Work Release Form
I give permission for
to use:
[name of instructor(s)]
[title of work]
OR
All work created in
[department and course number]
I authorize the instructor(s) to copy and distribute this work as a sample or
example with the understanding that all identifying information will be removed
prior to sharing the work.
I authorize the instructor(s) to copy and distribute this work with the understanding
that the instructor(s) will provide full and appropriate credit to me for my work.
I withhold authorization for any distribution of my work.
I understand that as a student of the University of North Carolina I retain ownership of all
academic work I create with the exception of cases outlined in the University’s copyright
policy (sponsored or externally contracted work, works for hire, and works authored by faculty
members with assistance from a student). My rights in the work include the right to publish,
reproduce, distribute, publicly perform or display the work.
(http://www.lib.unc.edu/copyright/policies.html See SectionV. D.).
Permission will exist indefinitely unless otherwise specified.
[class name]
[student signature]
[student contact information]
[date]