Copyright request to QCAA

The information you provide on this form will be used in administering copyright as part of legislative functions described in the Education (Queensland Curriculum and Assessment Authority) Act 2014 (s.18) and Financial and Performance Management Standard 2009 (s.17). Personal information will be accessed by authorised QCAA staff, and handled in accordance with the Information Privacy Act 2009. Certain types of personal information will be disclosed to government auditors where legally required.

r2569Rebranded July 2014

QCAA use: TRIM Ref: 13/ ( / )
Attention: QCAA Publishing Unit
Please send this form, plus a draft copy of the work, demonstrating how QCAA material is being used and acknowledged to:
Email:
Post: Manager, Publishing Unit, QCAA, PO Box 307, Spring Hill QLD 4004
Requesting organisation
Address:
Contact Details
Email:
Phone:
Fax: / ABN:
Requesting/Authorising officer: / Signature:
Date:
Note: Tax invoice for copyright fees, if applicable, will be forwarded to the Requesting/Authorising officer
Details of material to be reproduced
Type of source material:
Title of publication:
Portion (quantity) needed:
(i.e. Total number of words or graphics; Is this a whole document, section or page?)
Please indicate page references:
(Attach a separate sheet if needed)
Source material is presented: / Unchanged / Adapted / Integrated with other material
Percentage of QCAA material used, compared to the work as a whole:
Copyright request to QCAA / Queensland Curriculum & Assessment Authority
July 2014
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Publication and distribution
The publication in which we wish to use copyright material:
Purpose of publication:
Audience:
Total number of words in the publication: / words
Quantity produced: (if conference or workshop, no. of attendees)
Distribution: / Free to schools / Limited public sales / Training materials (public) / Other:(please specify)
Sale price / Attendance fee:
Additional information:
QCAA OFFICE USE ONLY
Permission is: / Granted / Declined / to use copyright material as described.
NO FEE REQUIRED
Fee (GST inclusive): / AUD / Other currency:
Conditions:
QCAA authorising officer
Name: / Position:
Signature: / Date: / / /
Comments:

Note: Include the section below if DET fee applicable.

DET OFFICE USE ONLY
Client invoice: / Created / Date: / Invoice number:
QCAA invoice: / Paid / Date: / Invoice number:
Client payment: / Received / Date:
DET notification to QCAA: / Emailed: / Date:
DET processing officer
Name: / Position:
Signature: / Date: / / /
Comments:
The information you provide on this form will be used in administering copyright as part of legislative functions described in the Education (Queensland Curriculum and Assessment Authority) Act 2014 (s.18) and Financial and Performance Management Standard 2009 (s.17). Personal information will be accessed by authorised QCAA staff, and handled in accordance with the Information Privacy Act 2009. Certain types of personal information will be disclosed to government auditors where legally required.
Copyright request to QCAA / Queensland Curriculum & Assessment Authority
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