Document Reproduction Permission Form

ResilienceNet

Permission Form for Electronic Document Reproduction

I/We accept an invitation from ResilienceNet and the Early Childhood and Parenting (ceep) Collaborative to include the following materials on the ResilienceNet World Wide Web site of resources to help children and families overcome adversities. Please list materials here (Use an additional sheet if you need more space to list other materials):

______________________________________________________________________________

Please indicate the copyright holder of this material (or indicate that the material is in the public domain):

______________________________________________________________________________

I/We also state that the person whose signature appears below either is the copyright holder or is authorized to sign for the copyright holder of the listed materials.

Materials are typically made available on ResilienceNet as documents in HTML format. Each Web document includes a note indicating the source of the material and the fact that it is being reproduced with the permission of the copyright holder (identified by name). Because users of Internet sites often wonder if items found there can be reproduced and distributed, each Web document may also include a note stating whether or not it can be freely reproduced. Please indicate whether you:

_________ DO give permission for any user of ResilienceNet to view, download, print, and otherwise reproduce your materials for educational or nonprofit purposes;

_________ DO give permission for any user of ResilienceNet to view, download, and print your materials; but DO NOT give permission to otherwise reproduce your materials for any other purpose.

An appropriate copyright and/or permission statement will be included with your publication on ResilienceNet. However, please note that, if you have not granted permission to reproduce your material, users of ResilienceNet are on the honor system to abide by your intention.

If you would like to have a special credit line and/or ordering information added to

each item, please indicate that information here (use a separate sheet if necessary):

______________________________________________________________________________

ResilienceNet editors will not make substantive changes to documents received for inclusion in ResilienceNet . However, ResilienceNet editors may make changes in document format or add bibliographic information to document headers and footers, and will add links to other ResilienceNet pages in the document footer. In addition, if the document contains hypertext links, ResilienceNet editors may remove or correct links that are no longer operative and may include an editorial note with such removal or correction.

Company/organization _________________________________________________________

Address: ____________________________________________________________________

______________________________________________________________________

City: __________________________________________ State: ______ Zip: ___________

Date: ______________________________

__________________________________ ______________________________

Signature Printed/typed name

___________________________________

Position

Please return this form with your materials for ResilienceNet to:

ResilienceNet Webmaster
c/o ceep
University of Illinois, Children’s Research Center
51 Gerty Drive
Champaign, IL 61820-7469

Or return the form by FAX to: (217) 244-7732

If you have any further questions about submitting material to ResilienceNet, contact the ResilienceNet Webmaster at resnet@ceep-mailserver.crc.uiuc.edu or at (877) 275-3227.

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