Learning Forward Permission Request Form

Please review our permission policy before completing and submitting this form.

Date ____________________

Name _________________________________________________

Title ________________________________________________

Organization _________________________________________

Mailing address ______________________________________

City _____________________State ____ Zip ____________

Phone _________________________________

Fax ___________________________________

E-mail ________________________________

Is the requesting organization a school, school district, or state educational agency? 
____Yes
____No


Is the organization a non-profit entity? 
____Yes
____No


Are you and/or the organization a member of Learning Forward? 
____Yes
____No

If yes, what is the membership number? ____________________

What do you want permission to use?

Title of article:________________________________________ 
Author of article:________________________________________ 
Publication:
___JSD    Vol.# ____ Issue# ____
___The Learning System    Month____ Year ____
___The Learning Principal    Month____ Year ____
___Tools for Schools   Month____ Year ____
___Results   Month____ Year ____
Other: ________________________________________
Date of publication ____________________

Title of article:________________________________________ 
Author of article:________________________________________ 
Publication:
___JSD    Vol.# ____ Issue# ____
___The Learning System    Month____ Year ____
___The Learning Principal    Month____ Year ____
___Tools for Schools   Month____ Year ____
___Results   Month____ Year ____
Other: ________________________________________
Date of publication ____________________

Title of article:________________________________________ 
Author of article:________________________________________ 
Publication:
___JSD    Vol.# ____ Issue# ____
___The Learning System    Month____ Year ____
___The Learning Principal    Month____ Year ____
___Tools for Schools   Month____ Year ____
___Results   Month____ Year ____
Other: ________________________________________
Date of publication ____________________

(Please submit an additional request form if you are requesting more than three articles.)

How do you intend to use the requested material?

___With a study group/committee/task force in my school or school district
How many copies do you want permission to make?____________________


___Workshop
What is the date of the workshop? ____________________
How many copies do you want permission to make?_______________


___Conference session
Name of conference _______________________________________
Date of the conference ____________________
How many copies do you want permission to make?_______________


___Reprint in a publication
Name of publication _________________________________________
Who receives this publication? ____________________
What is the publication's circulation? ____________________
What is the charge for this publication? ____________________


Please fax your request to Christy Colclasure (fax: 513-523-0638; email:christy.colclasure@learningforward.org) or mail to Christy Colclasure, 504 S. Locust St., Oxford, OH 45056.


Allow two weeks for a response.