Copyright Questionnaire

 

Name:

Address:

Company:

Email:

Phone (Home):

Phone (Cell):

Phone (Work):

Fax:

1 – Title

2 – Description of the work.

3 – In What Year was the work completed?

4 – State the name(s), citizenship(s), and date(s) of birth for the creator(s) of the work.

Author #1

Name –

Citizenship –

Date of Birth –

Author #2

Name –

Citizenship –

Date of Birth –

5 – Identify the nature of each author’s contributions to the work.

Author #1

Author #2

6 – If you are not the author of the work but you are claiming copyright, briefly state the basis of your claim.

7 – Is your work based on any pre-existing material or does it include any pre-existing material? If so, please identify the pre-existing material, and explain how your work differs.

Pre-existing material

Difference from your work

8 – If the material has been published or publicly distributed, please give the date of the first publication or earliest distribution and the nation of the first publication or earliest distribution.

Date of first publication or earliest distribution

Nation of first publication or earliest distribution

9 – Was the work created in an employment context? If so, please explain.

10 – Has this material, or an earlier version, been previously registered in the Copyright Office? If so, please explain.

Previous Registration Number

Year of Previous Registration

11 – Provide three copies of the work for which copyright protection is desired.