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Instructor s Name Department The University of Colorado Colorado Springs All instructors and departments at UCCS Types of Uses Please check all uses which you agree to Create physical copies for course packets classroom use placing on print reserve etc. Create digital copies to be posted to UCCS s content management system e.g. Blackboard Perform the work e.g. plays sheet music songs Other Attribution I we wish to be recognized as creator s of the work your name will be placed on the work I we wish to remain anonymous all identifying information including your name will be removed from the work over Certification of Authorship work identified above and that this work is not subject to any type of restriction e.g. copyright has been given to someone else that would prevent its use consistent with this permission. I we also attest that all aspects of the work are original to me us and have not been copied from other source. Permission to Use Student Work UCCS students own the copyright in the works they produce for their classes and their permission is required to use their work for any reason unrelated to the evaluation of their class performance. Authors/Creators Student Name All authors/creators of the work must be listed use additional sheets if needed Title of Work Course Name Period of Consent Section From // To // or Perpetual Consent Granting Permission I we the individual s listed above hereby authorized the following individuals departments institutions to use my work as described below. I we understand that I we retain the copyright in this work outside the permission granted here. Signature Instructor Provide a copy of this completed form to the student s and maintain a copy for your records. Permission to Use Student Work UCCS students own the copyright in the works they produce for their classes and their permission is required to use their work for any reason unrelated to the evaluation of their class performance. Authors/Creators Student Name All authors/creators of the work must be listed use additional sheets if needed Title of Work Course Name Period of Consent Section From // To // or Perpetual Consent Granting Permission I we the individual s listed above hereby authorized the following individuals departments institutions to use my work as described below.

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