HPU Academic Work Release Form

HPU Academic Work Release Form
Name

First Name Last Name
Email
example@example.com
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Date

MonthDay Year
Date
I give permission for blanks* to use: blank* (title of work).
or All work created in blanks* (department and course number).
Please select all that apply:*

I authorize instructor(s) to copy and distribute this work as a sample or example with the understanding that all identifying information will be removed prior to sharing the work.I authorize the instructor(s) to copy and distribute this work with the understanding that the instructor(s) will provide full and appropriate credit to me for my work.I withhold authorization for any distribution of my work.
I understand that as a student of the John Melvin University I retain ownership of all academic work I create with the exception of cases outlined in the University’s copyright policy (sponsored or externally contracted work, works for hire, and works authored by faculty members with assistance from a student). My rights in the work include the right to publish, reproduce, distribute, publicly perform or display the work.

Permission will exist indefinitely unless otherwise specified.
Signature*

Clear
Date*

MonthDay Year
Date
Should be Empty: