General Permissions Request Form

Information About You

Please enter your name, mailing address, phone/fax number and email address. Extra address lines should be left blank.

Name:
Company/Institution:
Address Line 1:
Address Line 2:
City:
State:
ZIP Code:
Country:
Telephone Number:
Fax Number:
Email Address:

Information About the ETS Materials You Wish to Reproduce

Title of ETS Publication from which you have selected material you wish to reproduce:
Edition:
Copyright Date:
Page Number(s):
Specific list of test questions, tables and/or other material you wish to reproduce:
Specify your intended use of our materials:
Will the materials be used for test preparation purposes? Yes No
If yes, please provide description:

Information About Your Product

Failure to complete the section below may delay the processing of your request.

The title of your publication(s)/product(s): (e.g., software, CD-ROM, printed materials, etc.)
The Publisher:
Approximate Publication Date:
Type of Publication:
Distribution Territory:
Retail Cost:
Anticipated number of copies
to be made:

Completed form will be submitted to:

Educational Testing Service
Office of the General Counsel
Attn: Copyright Administrator
Rosedale Road
Mail Stop 42-L
Princeton, NJ 08541, USA
Fax: 1-609-683-2930