Request for permission to Reprint, Adapt, or Disseminate Materials from this Website

Note: Please only use this form to request permission for use of JHSPH Center for Health Security materials. We will respond by email as quickly as possible.

Fields marked with "*" are required.

First and last name: *

Title:

Institutional affiliation:

Email address: *

Title and/or URL of article you are referencing in this request:

Are you requesting permission to: (check all that apply) *

Reprint for print publication. If so, please describe the intended use, purpose, and publication

Reprint to post on a website. Is so, please provide url, description of use, and anticipated length of use (i.e., limited period vs. indefinite period)

Adapt. If so please describe intended use, purpose, and publication.

Copy and distribute. If so, please describe intended use and audience.

Describe: *

Will anyone be charged for use of these materials? If yes, describe.

Additional information, description, or questions: