Permission Form
Request for Permission to Publish, Exhibit or Broadcast

Permission to publish, exhibit, or broadcast materials from the Archives and Special Collections, University of Nebraska-Lincoln Libraries (UNL Libraries) must be requested and granted in writing on this form. "Publication" includes: print, electronic/digital, including web publication, film, microfilm, or videotape. Publication of materials is subject to approval and fees may be charged for use. The UNL Libraries reserves the right to refuse permission to individuals and publishers who have not complied with its policies.

IN SIGNING THIS FORM, YOU AGREE TO THE FOLLOWING:
• Possession of a photocopy(ies) or a digital reproduction(s) does not constitute permission to publish, exhibit, or broadcast it.
• Item(s) will not be used for any purpose other that stated on this permission form.
• Credit will be given using the following citation: [Collection Name] Archives & Special Collections, University of Nebraska-Lincoln Libraries.
• Photographs may be cropped but not altered in any way as to appear different from the original.
• To pay use fees as specified on the Publication Fees Schedule. Use fees allow for one-time use only unless otherwise designated on this form. Use fees are assessed in addition to photocopy or reproduction charges. They are to be paid in advance of publication.
• Only those images actually used in publication are subject to use fees. If a request covers more than one form of publication, then the fees are assessed separately.
• To accept responsibility to secure proper permission from the creator, their heir(s) or designee(s) for any copyright permission necessary for publication.
• In requesting permission to publish, exhibit, or broadcast material in the UNL Libraries collections, I agree to indemnify and hold harmless the University of Nebraska, its officers and employees, from any action involving the infringement of the rights of any person or heirs and descendants in common law or under statutory copyright.

The information I have provided is correct. I agree to comply with the conditions described above:

Signature of applicant: ____________________________________________Date: ____________

Permission is hereby granted to publish, exhibit, or broadcast the item(s) specified, provided the applicant meets the conditions listed above and pays a USE FEE OF $______________. UNL Libraries retains all rights to the item(s) and does not surrender its own right to thereafter publish the item(s) or grant others permission to publish the item(s).

Signature of UNL Libraries Representative: _____________________________Date: ____________