UNIVERSITY OF MISSOURI
RELEASE
SAMPLE PERMISSION FORM TO USE PERSONAL CONTRIBUTIONS
Name of person seeking permission:
Name of work for which you are seeking permission:
Name of person who will "own" the permission:
Purpose for which you are seeking permission:
Reason for seeking permission:
Name of person(s) granting permission:
(Name)___________________________________________
(Signature) _________________________________________
(Date) _____________________________________________
(Please note: It is recommended that this document be signed and stored in a secure location)