Copyright request to QCAA
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: [email protected]
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
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.
r2569 Rebranded July 2014
Percentage of QCAA material used, compared to the work as a whole:
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
Training materials
(public)
Limited public sales
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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