Request Form

Permission for Use Request Form

Please complete and submit this form to request use of ANPD materials. If requesting use of multiple items, please submit each request form separately.

First Name

Last Name

Organization

Preferred Email Address

I am requesting to use *

If you responded Other above, please specify

What are you using it for, where will it be used, and what is the target audience for its use?

By checking the box below, the submitter agrees that:

1. The material will not be altered in any significant way unless permission is expressly granted by ANPD.
2. The material must contain an acknowledgement and the proper citation that the material is being used with permission from ANPD.
For example, ©ANPD 2022, Used with permission.
3. The permission is only applicable to the specified purpose above. Any additional uses must obtain separate permission from ANPD.
4. This license is subject to the laws of the State of Illinois.
5. Permission is not secured until ANPD staff acknowledges permission granted.

Please sign your name here to acknowledge you have read and agree to the above stated Terms of Use.

Once this form is submitted, please allow two (2) business days for a member of the ANPD staff team to review and follow-up. In certain instances, use of ANPD materials may incur a fee.

If you have any questions, please reach out to ANPD at info@anpd.org.

Submit