PERMISSION TO USE A COPYRIGHTED WORK

 ___________________________, hereby grants the University of North Carolina at Charlotte (“University”), the right to use, copy, distribute, publicly perform, make derivative works from, digitally transmit sound recordings, and publicly display a work, including digital reproduction and digital display on the internet or otherwise,  or portion of work entitled ___________________________(“Work”) under the terms set forth below.  The Work is a __________________[describe type of work].    __________________ holds the copyright in the Work.  ___________________________ represents that the Work does not infringe the copyright or other legal rights of any third parties.  The Work was copyrighted in the year __    .  

            All the following terms apply to this Permission:

The University may copy/reprint, including digital reproduction and digital display on the internet or otherwise the Work, and distribute and display it for use in _____________________ . 

The copies will be used solely for nonprofit educational purposes in accordance with the mission of the University.

            The copied material will not be sold.

This permission is non-exclusive, royalty-free (no cost to the University), world-wide, and perpetual.

All copies and displays of the Work by the University must credit _______________ as the creator of the Work, and must include full copyright information.  Please indicate the form of attribution preferred.

If there are any other entities with a copyright interest in this work, please provide complete contact information.

Agreed to By:

Copyright Owner signature:  _______________________________            Date:            ___ 

Printed Name:  ________________________________