PERMISSON REQUEST FORM - INSTRUCTIONS
Section 1: Applicant Information – complete this section by providing your name, the company you represent
(if applicable), the school you represent (if applicable), your email address, your mailing address, and your
telephone number.
Section 2: Rich Dad Title Information – complete this section by providing the name of the Rich Dad title and
the following information for such Rich Dad title: author, ISBN, edition number, copyright year, the page
numbers of the content you wish to use, and the web address where the requested material will be displayed (if
applicable).
Section 3: Requested Use – check the appropriate box for the use requested.
Section 4: Republication – complete this section only if you selected “Republication” in Section 3 by providing
the title of the work in which the requested material will appear and the following information for such title:
publisher, publication date, print run (the number of books you plan to print), the format/media (hardcover, trade
paperback or mass market, etc.), the territory in which you plan to publish (United States, Mexico, Worldwide,
etc.), and the language in which you plan to publish.
Section 5: Electronic Republication - complete this section only if you selected “Electronic Republication” in
Section 3 by providing the title of the work in which the requested material will appear and the following
information for such title: publisher, publication date, print run (the number of books you plan to print), the
electronic format (PDF, EPUB, MOBI, etc.), the web address where the requested material will be displayed (if
any), the territory in which you plan to publish (United States, Mexico, Worldwide, etc.), and the language in
which you plan to publish.
Section 6: Photocopying for Educational Use - complete this section only if you selected “Photocopying for
Educational Use” in Section 3 by providing the following information for such title: number of copies to be made,
the date the requested material will be used, and who will be receiving a copy of the requested material (include
the course title and the name of the professor/instructor).
Section 7: Electronic Educational Use - complete this section only if you selected “Electronic Educational Use”
in Section 3 by providing the following information for such title in: the electronic format (PDF, EPUB, MOBI,
etc.), the number of students with access to the requested material, who will receive copies (include the course
title and professor/instructor), the date the requested material will be used, and if using a website, whether or not
such website will be hosted by a third party.
Comments/Additional Information: complete this section if you have any comments or additional information
of which you would like us to be aware in reviewing your request.
Signature: You may print the Permission Request Form, sign it and scan it as a PDF, or you may type your name
on the signature line. By providing your signature or your typed name, you are certifying that all of the
information contained in the Permission Request Form is true to the best of your knowledge.
Submission of Permission Request Form and associated documentation:
Once you have completed the Permission Request Form, please forward the form to us utilizing one of the
methods listed below. You must include the following associated documentation as attachments to the
Permission Request Form:
1. The page in your title upon which the requested material will appear;
