Copyright Permission Request Form

Please make sure the material you want to use is copyrighted by The Review of Disability Studies: 
An International Journal (RDS).

After filling out the relevant information, email this form to rdsj@hawaii.edu

Additional contact information:
RDS, Center on Disability Studies, University of Hawaii at Manoa
1776 University Avenue, UA 4-6
Honolulu, HI 96822
Phone: 808-956-5688
Fax: 808-956-7878
www.rds.hawaii.edu

For use of RDS Journal material 
Date:

Your contact information:
Name:
Organization Name:
Department:
Complete postal address:

Country:
Office Phone:
Fax number:
Email:

1. The RDS material that you wish to use:
Complete Journal citation (Journal title, Authors, Article title, Publication year, Volume, Issue, 
and Pagination)

2. Material that you wish to use from the journal article (check box(s) and fill in information):
- Entire article 
- Portions of the article 
- Article Abstract only [Note: Abstracts may not be altered or edited in any way.]
- Figure 	RDS Figure number ___	RDS page number ___
- Table 	RDS Table number ___	RDS page number ___
- Appendix material 	RDS page number ___
- Other	Please specify:


3. I wish to use the RDS journal material in the following media (check box and fill in 
information as required):
- Print
- Electronic 	Please give details ___
- Both Print and Electronic 	Please give details ___ 
- Other 	Please give details ___

4. The material will be used in (check block and fill in information for one or more of the 
following):
- Journal or Newsletter
Title of journal or newsletter
Publisher
Is journal/newsletter 		PRINT		ELECTRONIC		BOTH
- A published Book
Complete citation of the planned book (Author(s)/Editor(s), Title, Edition, Publisher, 
Publication Date)

Print Run
The author(s) of your book chapter
- Presentation or Seminar
Title
Date
Number of copies needed
Is the presenter the author of the RDS material?	YES	NO
Is the Presentation or Seminar continuing education? 	YES	NO
Is there a fee for attendees? 	YES	NO
- Dissertation
- Thesis
- Other Uses (please specify)

- Classroom use/Print (Note: There may be a reprint charge for use of RDS materials in the 
classroom)
School name
Title of class
Semester
Instructor’s Name
Number of copies needed
- Classroom use/Electronic reserve.
Institution
Title of class
Semester
Instructor’s Name
Number of students enrolled
Is the web site password-protected?		YES	NO

5. Any additional information to tell us: