Permission Request Form | Brookes Publishing

All fields marked with an * are required. Incomplete requests will be returned to you for completion and resubmission. Our standard processing time is approximately 4–6 weeks from when you submit your complete request.

1. What Brookes Publishing material are you requesting permission to use?

Book/product title:*

Author(s)/editor(s):*

ISBN:

Copyright year:

Edition:

Name or description of item (see examples^† below):*

Page numbers(s)*:

^†Examples: "Figure 19: Cumulative number of words addressed to the child" or "Introducing the Idea of a Word" activity or "Chapter 6: Premature and Small-for-Dates Infants" or "Guidelines for Working with an Interpreter" from Chapter 3.

2. Have you previously received permission from Brookes to use this material?*

No
Yes - please provide the invoice or tracking number:
If no invoice or tracking number is indicated, please provide a copy of the previous permission letter.

3. Will this material be adapted or used as is?*
4. How will this material be used?*

in a book (Go to question 5a.) or in a journal article (Go to question 5a.)
in a coursepack (Go to question 5b.)
as a conference or seminar handout (Go to question 5c.)
on a web site (Go to question 5d.)
other (Go to question 5e.)

5a. If the material will appear in a book or journal, please complete the following:

Book/journal title:*

Chapter/article title:*

Author(s)/editor(s):*

Publisher (We will not grant permission until you have a publisher.):*

Publication date(month and year):*

Binding:* hardcover
paperback
other (please describe)

Est. print run:*
hardcover:
paperback:
other:

Total number of pages:*

Retail Price:*
hardcover:
paperback:
subscription fee:
other:

Rights requested (e.g., world English, United States English, world all languages):*

5b. If the material will be reprinted in a coursepack, please submit your request to Copyright Clearance Center (CCC) at www.copyright.com.
Please complete the following only if the material is not available via CCC. Requests for material available through CCC will be returned to you.

College/university:*

Instructor*:

Course name and number:*

Semester and year:*

Number of packs:*

5c. If the material will be reprinted as a handout for a conference, seminar, or training, please complete the following:
If your handout will also be posted on a web site, please also complete 5d.

Conference/seminar name:*

Presenter/speaker*:

Title of presentation:

Date of presentation:*

Location of conference/seminar:*

Number of copies:*

5d. If the material will be posted on a web site, please complete the following:

URL of web site:*

Date material will be posted:*

Duration of posting (i.e., when the materials will be removed from the web site):*

Is the web site password-protected?* yes no

5e. If you selected other above, please provide us with a description of how the material will be used:

Quantity (if applicable):

6. Please provide us with your contact information so that we can send you a response. (Those outside the U.S., please make sure to include your country and city codes when providing us with contact numbers.)

Name*:

Title:

Institution:

Address:

City:

State:

Zip code:

Country:

Phone:

Fax:

Email*:

(Your e-mail address will be used only for purposes related to your request. Brookes does not share or sell e-mail addresses — see our privacy policy for details.)

7. Additional information or comments about your request:

Please note: Please allow 4–6 weeks for your permission request to be processed.