Copying, Scanning, and e-Reserve Request

With Fair Use Assessment Certification

Name:______________________________________ Date Submitted:_______________________________

Date Needed By:__________________________

Desired Name for Electronic File:__________________________________________

Special Instructions (Circle those that apply):

  1. Place on e-Reserve
  2. Email to me
  3. Print one copy for personal use on:
    • Regular paper
    • Glossy photo
    • Transparency
  4. Scan in color
  5. Scan in Black & White
  6. Scan in Grayscale

File Type:

  1. JPG or GIF
  2. PDF (Acrobat)
  3. DOC (MS Word)
  4. Other:

Final Size:

  1. Same as original
  2. Other: __________________________

For requests exceeding commonly accepted “amount and substantiality” guidelines* or if the source to be copied is itself a copy:

____ I have made a reasonable and good-faith fair-use analysis, based on the four factors set forth in the fair-use provision of copyright law, and determined that the cumulative weight of the factors favors a finding of fair use in this case. (Please retain a written record, such as a checklist, documenting your decision-making process.)

____ I affirm that permission has been granted by the copyright owner for further reproduction. (Please retain a written record of this permission.)

____ I own the copyright.

____ This work is in the public domain.

Requester’s signature:_____________________________________



Amount and substantiality guidelines:

  • Single copying for teachers: a single chapter (or article, short story, short essay, short poem, chart, graph, diagram, drawing, cartoon, or picture).
  • Multiple copies for classroom use when there is too little time to request permission before use: a poem of less than 250 words on two pages or less, an article or story of less than 2,500 words, or a prose excerpt of up to 1,000 words or 10% of the work, whichever is less

Source: United States Copyright Office. Circular 21: Reproduction of Copyrighted Works by Educators and Librarians. Washington, D.C.: U.S. Government Printing Office, 1995.