Permissions

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*

Fax

CHARACTER COUNTS! affiliation

Name of member organization (if different)

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

Are you a graduate of a Character Development Seminar?*

Yes
No

Type of training

Year

Material Permission Request

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

Please describe:*

This field is limited to 2,000 characters.

Marketing Communications*

Yes. Please include me in your weekly newsletter mailing list.
No. I do not wish to receive marketing emails.

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 Institute 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 line: © 2019 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 2702 Forest Avenue, Des Moines, IA 50311.

Number of Impressions (if printed):

Please attach a sample draft of project:

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.

Phone