I hereby grant to Ball State University a non-exclusive perpetual royalty free license to use, duplicate and distribute the work (“Work”) in whole or in part:



Add Work Title Remove Work Title

The Work is to be deposited in the Ball State University Libraries’ collections and/or digital repository. I further grant to Ball State University the right to transfer the Work to any format or medium now known or later developed for preservation and access in accordance with this agreement. This agreement does not represent a transfer of copyright to Ball State University.

I represent and warrant to Ball State University that the Work is my original work and does not, to the best of my knowledge, infringe or violate any rights of others nor does the deposit violate any applicable laws. I further represent and warrant that I have the authority and/or have obtained all necessary rights to permit Ball State University to use, duplicate and distribute the Work and that any third-party owned content is clearly identified and acknowledged within the Work.

By granting this non-exclusive license, I acknowledge that I have read and agreed to the terms of this agreement and all related Ball State University policies.


Signatures and Certifications:

I, the undersigned, certify that I hereby agree with the statements above.


________________________________
     
________________________________
Print Name
     
Signature


________________________________
     
________________________________
Address
     
Date


________________________________

Address



Witness:

________________________________
     
________________________________
Print Name
     
Signature


________________________________
     
________________________________
Title
     
Date
After completing this form, click the Print Statement button to printout the form. Sign and submit the paper copy to your faculty advisor. In the Google Chrome browser, you can preview the paper copy before it prints.