Permission - Character Counts

Organization Information

Is your organization currently a CHARACTER COUNTS! member?*

Yes
No

Is your organization a nonprofit?*

Yes
No

Organization Name*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Website

Contact Information

Contact Name*

First Last

Title*

Email*

Enter Email Confirm Email

Phone*

CHARACTER COUNTS! Affiliation

Name of member organization (if different)

How many youth are (or will be) involved in CHARACTER COUNTS! activities at your organization?*

Material Permission Request

Please describe how you plan to use the logo/material.*

Limit 2,000 characters

By what date do you need the permission?*

Item Requested*

Logo
Book
Product
Workshop material
Other

Logo Name

Book Name, SKU or ISBN

Product Name or SKU

Workshop Material Name

Intended Use

1) Permission to reprint and Institute articles, logos or workshop materials is granted only for one-time use and only for purposes listed in the statement of intended use. Any additional reprints must be applied for in writing. 2) Permission does not include the right to syndicate, rent or loan. 3) If you wish to edit an article, the Center must approve the changes before it will grant permission. You may not alter or manipulate workshop materials in any way. 4) Proper credit for reprints must be given with the following lines: ©2022 The Robert D. and Billie Ray Center at Drake University. CHARACTER COUNTS! is a trademark of the Josephson Institute. Preprinted from (name of publication) with permission. www.charactercounts.org 5) One complimentary copy of the reprinted material for which permission has been given shall be furnished to CHARACTER COUNTS! Our mailing address is 2507 University Avenue, Des Moines, IA 50311.

Number of Impressions (if printed):

Please attach a sample draft of project:

Max. file size: 63 MB.

PLEASE CONFIRM:*

I have read and agree to all the conditions provided herein and am an authorized agent of the provided organization for this request.

Comments

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Permission Request Form

Organization Information

Contact Information

CHARACTER COUNTS! Affiliation

Material Permission Request

Intended Use