Application for Reproduction Permission
Sign in to Google to save your progress. Learn more
Contact Information
Request Filed By *
Email *
Mailing Address *
Phone Number *
Object Requested
Title *
Artist/Maker *
Accession #
Publication Details
Leave blank if not for a publication
Title
Publisher
Publication Data
Print Run
Location
Distribution
What formats is the publication available for? (e.g. print, website, video, e-book, merchandise, etc.)
Reason for Request
Briefly describe reason for request, including if the requested image is for museum, scholar, non-profit, or commercial purposes *
Format of File
Hi-res digital files will be provided in TIFF format unless otherwise indicated
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Wellesley College. Report Abuse