COPYRIGHT LICENSE: for use in paper or pdf format of the HomicidalImpulse Attack Scale(HIAS)

Dr. David V. Sheehan and Jennifer M. Giddens and Dr. Ivan Sascha Sheehan as “copyright holders” of the “HomicidalImpulse AttackScale (HIAS)”, hereinafter referred to as the “HIAS”, hereby grant permission to XXXXXXXX, a pharmaceutical company conducting international clinical drug development or a clinical research organization or a healthcare provider, to use the HIAS under the following terms and conditions:

Dr. David V. Sheehan and Jennifer M. Giddens and Dr. Ivan Sascha Sheehan, hereby grant permission to XXXXXXXX as sponsor of the clinical trials / clinical research organization / provider of healthcare, defined in Appendix 1 hereinafter, and to XXXXXXXX’s affiliated companies and subcontractors / clinical care setting, ONLY for the purpose of implementing such research studies / provision of care, defined hereinafter:

-the right to reproduce in paper format and in pdf format, but not in electronic or computer format the HIAS and its existing and future translations and to use it within its domestic and international clinical trials / your clinical care setting, upon individual request for each trial and number of uses in each trial;

-the right to use the translations of the HIAS,in the translations approved by the copyright holders, in collaboration with MAPI,for each trial as requested; MAPI Language Services is the exclusive coordinating center to ensure the production of consistent and conceptually equivalent translations of the HIASand to provide linguistic validation and certification of these translations and should be contacted directly for this purpose. MAPI Language Services may charge its own usual fees for this work.

Marie-SidonieEdieux

MAPI Research Trust

27 Rue de la Villette

69003 Lyon France

tel: +33 (0)4 72 13 66 67

fax: +33 (0)4 72 13 66 68/:+33 (0)4 72 13 69 50

-the unrestricted right to use all data and results generated from the use of the HIAS in domestic and international clinical trials / your clinical care setting.

-the right to use the HIASin rater training.

Such granting of rights to XXXXXXXX, its affiliated companies and subcontractors / your clinical care setting, to use the HIAS and its final translations, as hereinabove provided for, shall be free of charge.

In consideration of this granting of rights, XXXXXXXX, its affiliated companies and subcontractors / your clinical care setting, undertake to comply with the following conditions:

-XXXXXXXX, its affiliated companies and subcontractors / your clinical care setting, undertake to include on any reproduction of the HIAS, used within clinical trials / provision of healthcare, defined hereinafter, a mention redacted as follows:

© Copyright 2015 Sheehan DV, Giddens JM, Sheehan IS. All rights reserved.

Reproduced with permission of copyright holder only.

For permission contact

-XXXXXXXX, its affiliated companies and subcontractors / your clinical care setting, undertake to transmit to Dr. David V. Sheehan and Jennifer M. Giddens and Dr. Ivan Sascha Sheehan a copy of ANY and ALL final translations of the HIAS, in Microsoft Word and/or PDF format.

-In any publication resulting from the use of the HIAS, XXXXXXXX, its affiliated companies and subcontractors / your clinical care setting, SHALL NOT reproduce any part of the HIAS, or its translations, without the prior written consent of Dr. David V. Sheehan or Jennifer M. Giddens or Dr. Ivan Sascha Sheehan, copyright holders.

-The recommended citations for the HIASare:

  1. Sheehan DV, and Giddens JM. HarmResearch Institute. Homicidal Impulse Attack Scale (HIAS). RetrievedJanuary 7th, 2017 from:
  2. Sheehan IS. Professor Sheehan. Sheehan Research Scales. Retrieved December 12, 2016 from

It is hereby agreed that, except as otherwise set forth herein, no other right or license on HIAS shall be granted to XXXXXXXX, its affiliated companies and subcontractors / your clinical care setting, as a result ofthis license agreement, and that the rights attached to the HIAS and its translations shall remain the exclusive property of Dr. David V. Sheehan and Jennifer M. Giddens and Dr. Ivan Sascha Sheehan, copyright holders.

Please indicate your approval of the terms of this agreement by returning your completed and signed version of this agreement to . Dr. David V. Sheehan or J M Giddens or Dr. Ivan Sascha Sheehan will countersign this agreement on behalf of the copyright holders,and return it to you directly by email. If you make any changes to this agreement, use track changes in MS Word. Any such changes will be reviewed, and if acceptable, will be countersigned signed by one of the copyright holders, or amended further, and returned to you.

Agreed and accepted:

______

Signature of Dr. Ivan Sascha Sheehan, copyright holder orDate

Signature of Dr. David V. Sheehan, copyright holder or

Signature of Jennifer M. Giddens, copyright holder

For XXXXXX, the sponsoring company / CRO / healthcare provider / clinical care setting, requesting permission:

______

SignatureDate

Print Name and Title: XXXXXX

Phone: XXXXXXXXX

E-mail: XXXXXXXXXX

APPENDIX 1

Clinical trials specific to this permission request are defined below.

Permission has been granted to XXXXXXXX, its affiliated companies and subcontractors / a health care provider, to use the HIAS, as designated by the terms mentioned above and signed by Dr. David V. Sheehan or Jennifer M. Giddens, as copyright holders, for the following clinical trials / clinical care setting ONLY, until further request and permission has been granted for studies not listed hereinafter:

Row / Product/Compound /

Study Identification Number

/

Projected number to be randomized to all study medications at baseline visit per protocol / clinical care setting

1 / XXXXX / XXXXX / XXX
Projected number of times HIASwill be used in your study / clinical care setting
2 / XX
Budget for Study being conducted using the HIAS at no cost*:
US $______ / Projected number of HIAS administrations in your study / clinical care setting
(Row 1 above X Row 2 above)
3 / XXXX

______

Signature of Dr. Ivan Sascha Sheehan, copyright holder orDate

Signature of Dr. David V. Sheehan, copyright holder or

Signature of Jennifer M. Giddens, copyright holder

Non-Profit settings:

Individualresearchers, clinicians and students, working in nonprofit or publiclyowned settings, (includinguniversities, nonprofithospitals, and government institutions), maymakepaper copies of the HIASfor theirownpersonalclinical and research use, but not for institutional use.

In these settings the HIASmaybereproduced in paper format and in PDF format, but may not becomputerized in these settings withoutwritten permission from Dr. David V. Sheehan or Jennifer M. Giddens or Dr. Ivan Sascha Sheehan. The HIASmay not beposted on anyinstitution’swebsite. Any use involvingfinancial gain requires a license agreement signed by the copyright holder and payment of a per use licensingfee.

* Any use of the HIAS in a research study with a budget above US $50,000, and which involves bringing in overhead to the participating institution, requires a license agreement signed by the copyright holder and payment of a per use licensing fee.

For-Profit settings:

The use of the HIAS for any “for profit” use or in any “for profit” setting is not free and requires a license agreement signed by the copyright holder and payment of a per use licensingfee. In “for profit” settings no part of the HIASmaybereproduced or transmitted in anyform, or by anymeans, electronic or mechanical, includingphotocopying, or by any information storage or retrieval system, withoutwritten permission fromDr. David V. Sheehan or Jennifer M. Giddens or Dr. Ivan Sascha Sheehan.

The HIASmay not becomputerizedwithoutwritten permission from Dr. David V. Sheehan or Jennifer M. Giddens or Dr. Ivan Sascha Sheehan. For permission contact