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The ChildTrauma Academy
Materials Reproduction Request Form
Please see directions/guidelines below
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Requestor
Information
Contact Person: ________________________________
Agency/Organization: ______________________________________________
Address: _________________________________________________________
City: ______________ State:
____ Zip Code: _______
Phone: ( )___________
Fax: ( )___________
E-Mail: _________________________
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| Title(s) Requested for Reproduction:
_____________________________________________
_____________________________________________
_____________________________________________
Intended Use:
__________________________________________________
Approximate Number of Copies: _______
Name and date of publication (if applicable):
________________________________________________________________
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-- To send this request form --
Please copy this page into a Word document, complete the
requested information, and email it as an attachment to
childtrauma1@aol.com.
You're welcome to include a cover letter (optional).
Guidelines:
If you are interested in reproducing more than three copies of any single article or intend to reproduce an article in a newsletter or like format, please complete this form and email it back to us for our review. Requests are reviewed regularly.
Individual use for clinical or educational purposes does not require permission, provided that reproduction is for nonprofit educational use and that copyright and attribution information is retained. |
