Lycoming Archives Research Agreement
Contact Information
* First Name: ________________________
* Address: __________________________
* Last Name: ________________________
* Country: __________________________
* City: _______________ * State: _______________ * Zip: ________________
* Email: ____________________________ * Phone #: __________________________
Research Information
Brief description of project:
Request Date: ________________________ Completion Date: _____________________
Do you plan to publish?: ________________
Do you agree to acknowledge Lycoming
College Archives and seek appropriate permission?: ___________________
Permission to reproduce materials does not constitute permission to publish. Factors such as
copyright, donor restrictions, and physical condition may affect request for copies. Some
published works, unpublished manuscripts, graphics, and recordings cannot be reproduced
without written permission of the copyright holder.
While staff will make every effort to conduct a thorough search, Lycoming College cannot
guarantee information can be located. Your application will be reviewed by the appropriate
College Administrators.
I will abide by the archival procedures and etiquette of the Lycoming College Archives as
directed by the Archival staff.
Please print, sign and turn this form to Sean Baker.
Signature: _____________________________________________________________________