Request to Use NCSA-Copyrighted Material

Please complete this form requesting permission to use copyrighted material (images, video, etc.) held by the National Center for Supercomputing Applications (NCSA). If your request is approved by the Board of Trustees of the University of Illinois through NCSA (“Grantor”), Grantor will sign and return this form to the individual/organization requesting the material (“Grantee”). In signing, Grantor represents that Grantor is the sole owner of the material and that Grantor has all rights necessary to grant such permission in the form of a non-exclusive, revocable license.

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Information about Grantee







answer must be an email address



Material Requested by Grantee

Do you need NCSA to provide a digital file for this image?


Description of Requested Use







Purpose of Requested Use

Please describe the purpose for which Grantee wishes to use the NCSA material. Please check all that apply.

Format of Requested Use

Please describe the context/format in which Grantee wishes to use the NCSA material. Please check all that apply.


Method of Distribution

Please describe the method Grantee will use to distribute the NCSA material. Please check all that apply.





Grantee may not modify requested material without express written permission from NCSA.

Terms of Use

Material may be used only for the purpose stated in this request. Material may not be sublicensed to any other entity or individual. Grantee agrees to submit a sample of the completed work to NCSA with the date of publication. Grantee grants permission to Grantor to display the sample on Grantor’s website(s) to publicize and promote the use.

*** You are not authorized to use NCSA material until this form has been submitted and you have received written approval from NCSA Communications. ***

required Include your email address in your submission to:

  • Get a copy of your answers

This form approved by University Legal Counsel February 5, 2020. Any revisions to this form other than Grantee-provided information will require University Legal Counsel review and approval.