Special Collections Duplication Application
Cal Poly Humboldt Library Speical Collections Application for Duplication

Conditions
1. Duplication, in whatever format, e.g., photocopy, photograph, copy print, scanned image, is made available solely for the reference use of the applicant.

2. In making this copy available, the University Library does not thereby grant permission to reproduce or quote extensively for publication or to display on the world wide web. Requests for such permission must be submitted in writing with sufficient lead time for processing (see below).

3. When material from the University Library's Special Collections is published, including on a web page, acknowledgement of permission to publish and credit for the possession of such material must be noted in the work. The credit line should read as follows: (Name of collection), Cal Poly Humboldt University Library.

4. The University Library does not, by making copies available or by granting permission to publish or to quote therefrom, relinquish its own right to publish the material or to permit other persons to publish or quote therefrom.

5. The applicant assumes full responsibility for any infringement of copyright or publication rights belonging to the author, his heirs, or assigns.
Sign in to Google to save your progress. Learn more
Terms of Agreement *
Required
Date *
MM
/
DD
/
YYYY
Full Name *
Street Address *
Phone Number *
Email address *
Affiliation/ Purpose *
Request to Publish. A use fee of $50/image is charged for commercial publication purposes, payable to Cal Poly Humboldt University Library. This fee is for a one-time use of the image(s). Humboldt will release the image(s) when the payment is received. *
Place of publication, including website
Item Number(s)
List all the items you are requesting. List [title of object]- [photo id number] Example: Group poses in front of Redwood Log- 1234.56.7891
Resolution
If you need a particular image resolution, please indicate here
Clear selection
File Type
If you need a particular format, please indicate here
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Cal Poly Humboldt. Report Abuse