Please indicate your status from the selections below.

XU Undergraduate
XU Graduate
XU Faculty/Staff
XU Alumni
Other

Image Information:

Please describe in as much detail as possible the image that you want reproduced.

If you have seen the image in a Xavier digital collection, include the ID number and description or caption if available.

Type the image description and/or caption here.

If you have seen the image online please provide the Internet address (URL):

Other possible sources of information:

Additional Descriptive Information:

Rare Book Information:

Please provide author, title and call number information if available of the rare book you want reproduced.

Author:

Title:

Pages to be Reproduced:

Call Number:

Yes:     No:

Agreement:

The materials in Xavier University library archives, special, and digital collections may be used by individuals for private study or any fair use as defined in Section 107 of the U. S. Copyright Law. Please credit the creator (if known) as well as Xavier University Archives and Special Collections, Cincinnati, Ohio.

These materials may not be used for purposes that do not qualify as fair use and they may not be transferred, recopied, exhibited, displayed, broadcast, or published in print or digital without first obtaining permission from the copyright holder. In many cases Xavier University can claim only physical ownership of these materials and it is the obligation of the applicant to fulfill any requirements of copyright law. In addition, use of some materials may infringe upon the rights of copyright holders unknown to Xavier University and the applicant is responsible for satisfying any claims of the copyright holder. The applicant shall indemnify and hold harmless Xavier University archives, special, or digital collections against any and all claims by third parties.

I have read and agree to observe the conditions in the above statement. I assume all copyright responsibility for the items in this request, and indemnify and hold harmless Xavier University, its trustees, officers, employees, and agents from any and all liability arising out of my being granted permission to reproduce the materials identified in this form. I also agree to accept financial responsibility for any reproductions made as a result of this request.

Yes:     No:

Contacts:

If you have questions or difficulty completing this form please contact:

Tim McCabe, Archives Librarian
mccabe@xavier.edu
513 745-4821

Marty Ferrell, Collection Development & Special Collections Librarian
ferrell@xavier.edu
513 745-4806