Permissions Request Form
If you are seeking permission to reproduce copyright material from a Pearson Australia Product, please complete the following details of the extract or figure to the Rights & Permissions Department with your request to reproduce copyright material.

Please note that we cannot grant permission for any material that appears in our Products with credit to any other source. Please review the material you are requesting to ensure that Pearson controls the rights. If the material is acknowledged i.e. on the acknowledgements or imprint pages, credit or source lines, to another source other than Pearson, the material is not ours. If another source is cited, permission must be obtained from the original source. Unfortunately we cannot always provide contact names for other sources.

If no additional information is required, you can expect a response within two-four weeks from the submission of this form.

If you are requesting material from multiple Pearson Products, please submit a form for each Product.

If your request is for content from a Pearson US title please fill out the form here: http://www.pearsoned.com/permissions/

And for Pearson UK: http://uk.pearson.com/home/permissions.html

Please contact us for further information Australiapermissions@pearson.com.

Information about material requested
Please provide all Product information as requested below
ISBN *
Please note the ISBN from which the material comes from
Your answer
Author *
Your answer
Title *
Please not the title from which the material comes from
Your answer
Copyright Year *
Your answer
Material requested *
Please include what the material is (tick all that apply)
Page/s and/or figure number/s requested *
Please note the figure number/s (if applicable) and page/s on which the material appears
Your answer
If material is an extract, how many words are being used?
Your answer
If material appears online, please provide the URL below:
Your answer
For requests from Schools
If you are a teacher or educational officer and intend to use the material for classroom use, please fill out the additional information below:
Has the Product been adopted by your school?
Has the School purchased the Product for all students?
Intended use: Classroom
If you are a teacher or educational officer and intend to use the material for classroom use, please fill out the following:
Format
Please check all that apply
Number of copies
Your answer
Duration of use
Your answer
Intended use: Publication
For any other use besides "Classroom", please fill out the following:
Format
Please check all the apply
Territory
Your answer
Language/s
Your answer
Duration (term of use)
Your answer
Publication/reprint title
Please provide the details of your publication/product below
Your answer
Publisher
Your answer
List price
Your answer
Number of pages
Your answer
Intended use: Internet/Intranet/Broadcast
If you have indicated use of our material for the internet, intranet or broadcast, please fill out the following:
Who will have access?
Number of people who will have access
Your answer
URL address where content will appear
Your answer
Duration of access (till what date will the material be available)
MM
/
DD
/
YYYY
Will access be secure and/or password protected?
Please note that if you answer 'no', permission will not be granted
Contact Information: Schools
Full name
Your answer
School
Your answer
School address
Your answer
Email
Your answer
Phone no.
Your answer
Contact Information: all others
Full name
Your answer
Job title
Your answer
Company name
Your answer
Mailing address
Your answer
Email
Your answer
Phone no.
Your answer
Attachment
Please email all attachments to australiapermissions@pearson.com.au and note in the subject matter, 'Permission request' and the date this form is submitted.
Attachment supplied
Further Information
If you have further information pertaining to your request, please note it below:
Your answer
Terms & Conditions
It is a condition of this request that you verify and agree:
a. That all the information provided is accurate and correct at the time of submission
b. Pearson owns all rights to the material including copyright, and permission is for non-exclusive use only. The requestor has only the right to use the our material for the purposes set forth in this request.
c. Use of Pearson material online is secured, password-protected and any text set.
d. A fee may be incurred as a result of your request
e. Pearson is acknowledged appropriately as the originator of the material with the following credit line, "Reproduced with permission from [author, title, copyright year, Pearson Australia, page nos."

You agree not to otherwise reproduce, use, sell, transmit, publish, broadcast, or otherwise disseminate or distribute our material to anyone, including but not limited to others in the same company, school, college or other organisation, whether or not for a charge or other consideration, including but not limited to use in connection with the sale, retransmission, distribution, publication, broadcasting, circulation or other dissemination, for any purpose, whether commercial or otherwise, without the express prior written permission of Pearson.

I verify that the above answers and verifications are complete, true and correct and that by submitting this request, I am agreeing to abide by these terms. *
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