I give permission to present and reproduce samples of my work produced in __________ Section ____ for instructional purposes only at Texas A&M University. This does not give permission for my work to be included in any published journal, book, web page, or other document meant for general or academic public consumption. If my work is chosen for publication of this sort, the information on this form may be used by the author(s) to obtain my explicit permission.

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(Name, printed)

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(Signature)                                                                                    (Date)

 

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(Student ID #)

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Local Address

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Permanent Address

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Home Phone

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E-mail