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Media Request Form

Please Read: We do not accept requests directly from students, including student email addresses. Additionally, we do not accept requests from non-academic email addresses. In the Faculty Web Page field below, please include a link directly to your faculty listing at an academic, not for profit, degree-granting institution. Upon receiving your Statement of Use, please sign and return it as a PDF attachment from the same email address used to make your initial request. It may take up to 30 days to process your request from the date we confirm receipt of your signed and valid Statement of Use. 


Please Note: The most frequent cause of delays receiving these materials is failure to provide a link to an official academic webpage that displays your status as PhD holding faculty at that institution.



*required fields  
Media INVALID
*Name (first name last name)
*Academic Institution
*Department
Student's Name, if applicable
*Address
*City
State/Prov
*Country
Zip Code
*Phone (###-###-####)
*Valid Academic Email Address
*Faculty Web Page

 

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