Orphan Works Licensing Application Form
Submit this form to apply for permission to use an orphan work. Please provide complete and accurate information.
Full Name of Applicant
*
First Name
Last Name
Organization (if applicable)
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Title or Description of Orphan Work
*
Type of Work
*
Please Select
Book
Photograph
Artwork
Film/Video
Music/Sound Recording
Other
Known Details of Creator (if any)
Summary of Search for Rights Holder (methods, sources, dates)
*
Intended Use of the Orphan Work (purpose, medium, duration)
*
Upload Supporting Documents (search records, evidence, etc.)
Upload a File
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