Student Work Permission Form

Professor [Name:__________________] requests your permission to post the following examples of your student work for [name of course:_______________] (each a "Work") on his/her [name of College:_______________] faculty website:

[Describe works]



The individual signing below acknowledges and agrees as follows:

1. I am age 18 or older.

2. I have read and understand this Permission Form.

3. I am the sole creator of the Work(s).

4. Professor [name:_______________] has my permission to make an electronic copy of each Work and post any or all of the copies on his/her [name of College:______________] faculty website for such period of time as he/she sees fit.

5. I agree that my name may be used on the website to identify me as the creator of the Work(s).

6. I release Professor [name:________________], the College and The City University of New York from any and all claims that I might have in connection with the Professor _________________'s use of the Work(s) pursuant to this Permission Form.


Printed Name:_______________________________