A&SC Image Use Agreement Request Form
Permission is required to copy or publish portions of materials from the collections. To use any image from the collections in publications, displays, exhibitions, or other non-personal use, we require patrons to complete an Image Use Agreement form.

Archives & Special Collections must be credited on all photographs and documents used in publication. One copy must be submitted to Archives & Special Collections of any publication in which an image from our collections is utilized.
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Contact Information
For the individual and/or associated organization, corporation, or group requesting to use these images.
Name *
Address *
Email Address *
Phone Number *
Publication Information
Information about the work in which the image(s) will be used
1. Entity Requesting Permission: What is the official name and address of the individual, organization, corporation, or group requesting to use the image? *
2. Effective Date: What is the anticipated date of publication? *
3. Image(s) involved: Please give the official title of the images, dates, photographs, and sources of information, as applicable. If you are citing an image from our digital collections, please indicate the Identifier or File Name of the requested image. *
4. Work in which image is to be used: What is the official or working title of your publication? *
5. Permitted Usage of Image: Describe the conditions of the use of the image. *
6. Territory: Please describe how your publication will be distributed. If images will be part of an exhibit, please indicate how your exhibit will be made available and who are the intended visitors. *
7. Term: Permission is given only once. If no time limit is specified, the term would be perpetual. *
8. Credit: A credit must be used to describe that the image was provided by Archives & Special Collections, University Library, Santa Clara University.  Please indicate if you agree to this provision by typing your initials below. *
9. We ask that you please provide a complimentary copy of your publication, including catalogs or promotional literature. Please indicate if you agree to this provision by typing your initials below. *
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