Permission to Publish Request

Requester Information

Name (First): *

Name (Last): *

Address: *

Country: *

City: *

State: *

Zip: *

Phone: *

Email: *

Institutional Affiliation *

Source Information

Where did you find the item(s)? *

Select all that apply (choose at least one)

Please give us further information about the sources by completing the required field(s) below:

Collection Title: *

Digital Collection URL: *

Calisphere URL: *

OAC URL: *

Full Citation: *

Other information: *

Use of Item

Please give us more information about the planned use by completing the required field(s) below:

Book Publisher: *

Article Publication title: *

Website URL: *

Film title: *

Program title: *

Exhibit information: *

Other use details: *

Items Requested
Coll. Code/Call Number*	Collection or Book Title*	Title or Description of Item
Coll. Code/Call Number *	Collection or Book Title *	Title or Description of Item

Additional Description of Material

Additional Information

Regardless of whether CSUN holds copyright in the items described above, a citation or courtesy line that refers to Special Collections & Archives, University Library, California State University Northridge as the owner of the physical materials must be included in your work. Requesters can consult a style manual, see the Citing Archival Materials Guide, or use the following courtesy line:

[Identification of item], [Collection Name], Special Collections and Archives, University Library, California State University, Northridge.

I previously submitted a Duplication Request for the item(s) described above.

Duplication Request