Academic Permissions Service Form
The APS form is used in obtaining copyright permission from the publisher and rights holder of previously printed material via the Copyright Clearance Center. Previously printed material is material from books, magazines journals, anthologies and websites. The APS form is used in obtaining our first level of permission request. In most cases permission is granted from the APS form. Filling out the spaces with the diamonds ♦ are mandatory for obtaining permission. The omission of any specific information on the APS form will result in the denial of your permission request. Please type or write clearly.
Document Reference & Account Reference Filled in by the
staff of Duplicating Services.
Start of Term The date of the first day of classes.
Educational Institution Temple University.Course Name and Course Number This information is not required by CCC but is necessary for Duplicating Services to process your order.
Instructor The instructor(s) full name(s). If more than one instructor is teaching the course send a note with the order detailing all the instructors teaching, their course and section(s) number(s) and the locations where they are teaching.
No. of copies This is number of students enrolled in your class(es). If you are requesting more than one complimentary copy or do not want a <>complimentary copy, send a note with the order.
ISBN/ISSN This information is not required by CCC but is useful in locating hard to find permissions.
Title This is the name of the title of the book or title of the journal or news article.
Publisher The name of the publisher is the primary piece of information in obtaining copyright permission. This along with information is usually found on the inside front cover of all books.Chapter/Article This information is important for journals, newspapers and anthologies.
Author The name of the person who wrote the material.
Published Year (4 digits) The year the material was published. If there are multiple dates list the most recent copyright date.
Volume Required for material from journals and/or magazines.
Edition Required for material from journals and/or magazines.
From page number – To page number The first page of the material you want copyrighted to the last page if the pages are in consecutive order. If the pages are not in consecutive order they have to be listed as a new item. When using a newspaper article and it starts on A6 and continues on A12 you can list that as one item.
Total number of pages This is the total number of pages asking requesting permission for. (Example) A6-A10 (2 pages), 312-320 (8 pages). To expedite clearances, no more than 25% of any title should be requested.
Your reference number For your record keeping only. Unnecessary for copyright permission.
Number of Copies (if different from above)
Date of issue If you have this information include it with your submission.
