Permission to Use Student Work

1. Grant of Permission. I, the undersigned, am a student at Indiana University (“IU”), and I hereby give to IU my permission to use the following work (the “Work”):
[Insert description of the Work prepared by the student.]

2. Scope of Permission. This permission extends to the use of the Work as described below:
[Insert specific description of the permitted use of the Work, e.g., “Inclusion of the Work on a website based at IU operated by Professor Smith, accessible without restriction, in connection with History 101, for a period of two years from the date below.”]

3. Certification of Authorship. I am the owner of the copyright to the Work, and the Work is not now subject to any grant or restriction that would prevent its use consistent with this permission. Except as explicitly indicated on the Work, all aspects of the Work are original to me and have not been copied or adapted from other sources.

4. Privacy Release. I hereby authorize and consent to the release, maintenance and display of my name, status as a student at IU, and any other personal information I have provided in connection with the Work and its use by IU. This authorization also includes the disclosure of the content of the Work itself and any associated information. I hereby release The Trustees of Indiana University, its member trustees, officers, employees and agents, and any other person who may be legally liable, from any and all claims, demands, causes of action, and suits, including but not limited to claims for invasion of privacy, defamation, breach of contract or other breach of duty (including, e.g., the Family Educational Rights and Privacy Act, the Indiana Rights of Publicity Act, the Indiana Access to Public Records Act, etc.), arising out of or in connection with the maintenance, use or release of any personal information as described above.

Signature of Student: ____________________________

Printed Name: _________________________________

Date: ________________________

Address or other Contact Information: ______________________________________
_____________________________________________________________________

Notes:
The student and the individual responsible for the project in question should retain signed copies of this document for their records. This document was developed by the Copyright Management Center and the Office of University Counsel at IUPUI (www.iupui.edu). Version: April 2002.

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