JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Duplication Request Form
Submit this form to order reproductions of photographs, oral histories, music recordings, and film or video from Eastern Kentucky University Special Collections & Archives.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Duplication & Use Fees
Duplication Fees apply for any use other than EKU class projects or EKU office use.
Some material may not be available for copying due to restrictions.
All reproductions are sold for personal/reference use only, and may not be displayed, published or broadcast in any format without payment of appropriate Use Fees.
All responsibility for questions of copyright that may arise in copying and in use of the copies must be assumed by the user.
Please do not send payment until you hear back from us.
For more information, see:
Special Collections & Archives: Duplication & Use Fees
*****************
STAFF USE
Dup Stat (date):
WMS Stat (date):
Delivered (date):
Your Initials:
*****************
Please click the box below before submitting this form:
*
-
Required
Your Name:
*
Your answer
Email Address:
*
Your answer
Address (city/state/zip code):
*
Your answer
Phone:
*
Your answer
Date needed:
MM
/
DD
/
YYYY
Are you a Kentucky resident?
*
Choose
Yes
No
Are you an EKU student or staff member?
*
Choose
Yes
No
(FOR STUDENTS OR INSTRUCTION) Class Name (ex. BEM 240):
Your answer
Material type:
*
Choose
Image
Video
Audio
Book
Manuscript
What is the intended use of the material?
*
Choose
Advertisement
Campus display
Class project
Home display
Personal research
Printed material
Public display/exhibit
Other
If you selected "other," please describe the nature of your project:
Your answer
Will the material be used for profit?
*
Choose
Yes
No
Image/Item/Call Number(s):
*
If you are requesting more than one item, please hit "enter" after each item (to make it easier for us to read).
Your answer
DPI and/or file format needed (if known):
Your answer
By clicking here, you agree to the terms set forth in the
Conditions of Use
:
*
Yes
Required
To prove you are not a robot or spambot, please answer the following question: 2+3= ?
*
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Help Forms improve
Report