Permission request form for ETS materials

Permission Request Form for ETS Materials Permission Request Form for ETS Materials Please complete all areas that apply and leave any non applicable boxes blank Requester’s Name Company/Institution A[.]

Clear Form Permission Request Form for ETS Materials Please complete all areas that apply and leave any non-applicable boxes blank Requester’s Name: Company/Institution: Address: _ Country: _ Phone Number: _ Email: _ Date permission is needed by: (Please note that there is a standard 4-week turnaround time) ETS Material Requested Title of ETS Publication: _ Website Source: _ (If you not have an active link where the ETS material is stored, please provide a copy of the ETS content you are requesting.) Copyright Year: _ Edition: _ Page(s): Please provide any additional information regarding the ETS material you wish to reproduce below: Page of Your Product Will your material be used in (check all that apply): Research? Dissertation? Test/Preparation? Other (please describe): _ Please provide your intended use of ETS materials: Title of finished Publication/Product: Type of Product (print material, electronic, etc.): If electronic, you intend to use the material on a secure (password protected) website, non-secure website, or both? Secure Non-secure Both Editor: Anticipated Publication Date: _ Number of Print Copies: _ Author: _ Distribution Territory: _ Number of Electronic Copies: _ If your request is approved, we ask that you submit a copy of your finished product identified with your unique ETS reference # to permissions@ets.org Page of ... Electronic Copies: _ If your request is approved, we ask that you submit a copy of your finished product identified with your unique ETS reference # to permissions @ets. org Page of ... Test/Preparation? Other (please describe): _ Please provide your intended use of ETS materials: Title of finished Publication/Product: Type