Reproduction Requests Form Back to Conditions for Materials Use Statement Name* First Last Email* Phone*Are you a UT student, faculty, or staff member?*YesNoUT students, faculty, and staff receive 10 free scans per semester from each department (Digital Collections, Special Collections, Map Collection)Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe RequestItems from*Digital CollectionsMap CollectionSpecial CollectionsTheses and DissertationsNumber of Items Requested*12345Item RequestedAuthor*Title*Date*Publisher*Publication Date*Call Number*MS/AR/MPA Number or Call Number*Box Number or Page Number (if applicable)Folder Number (if applicable)Address (URL) of Image File Requested*Ex. http://diglib.lib.utk.edu/image1Image or Collection Name*Format NeededLow Resolution Scan - $3.00High Resolution Scan (400 dpi minimum) - $10.00Black and White Print (2.5 feet x 2 feet) - $2.50Black and White Print (2.5 feet x 3 feet) - $3.75Black and White Print (2.5 feet x 4 feet) - $5.00Black and White Print (2.5 feet x 5 feet) - $6.25Black and White Print (3 feet x 2 feet) - $3.00Black and White Print (3 feet x 3 feet) - $4.50Black and White Print (3 feet x 4 feet) - $6.00Black and White Print (3 feet x 5 feet) - $7.50B&W Printing - Price: 50 cents sq. ft. Please select the option that best fits your desired size.Hign Resolution Scan Price: $10.00 Format NeededLow Resolution Scan - $3.00High Resolution Scan (400 dpi minimum) - $10.00Item Requested - 2Author*Title*Date*Publisher*Publication Date*Call Number*MS/AR/MPA Number or Call Number*Box Number or Page Number (if applicable)Folder Number (if applicable)Address (URL) of Image File Requested*Ex. http://diglib.lib.utk.edu/image1Image or Collection Name*Format NeededLow Resolution Scan - $3.00High Resolution Scan (400 dpi minimum) - $10.00Black and White Print (2.5 feet x 2 feet) - $2.50Black and White Print (2.5 feet x 3 feet) - $3.75Black and White Print (2.5 feet x 4 feet) - $5.00Black and White Print (2.5 feet x 5 feet) - $6.25Black and White Print (3 feet x 2 feet) - $3.00Black and White Print (3 feet x 3 feet) - $4.50Black and White Print (3 feet x 4 feet) - $6.00Black and White Print (3 feet x 5 feet) - $7.50B&W Printing - Price: 50 cents sq. ft. Please select the option that best fits your desired size.Hign Resolution Scan Price: $10.00 Format NeededLow Resolution Scan - $3.00High Resolution Scan (400 dpi minimum) - $10.00Item Requested - 3Author*Title*Date*Publisher*Publication Date*Call Number*MS/AR/MPA Number or Call Number*Box Number or Page Number (if applicable)Folder Number (if applicable)Address (URL) of Image File Requested*Ex. http://diglib.lib.utk.edu/image1Image or Collection Name*Format NeededLow Resolution Scan - $3.00High Resolution Scan (400 dpi minimum) - $10.00Black and White Print (2.5 feet x 2 feet) - $2.50Black and White Print (2.5 feet x 3 feet) - $3.75Black and White Print (2.5 feet x 4 feet) - $5.00Black and White Print (2.5 feet x 5 feet) - $6.25Black and White Print (3 feet x 2 feet) - $3.00Black and White Print (3 feet x 3 feet) - $4.50Black and White Print (3 feet x 4 feet) - $6.00Black and White Print (3 feet x 5 feet) - $7.50B&W Printing - Price: 50 cents sq. ft. Please select the option that best fits your desired size.Hign Resolution Scan Price: $10.00 Format NeededLow Resolution Scan - $3.00High Resolution Scan (400 dpi minimum)Item Requested - 4Author*Title*Date*Publisher*Publication Date*Call Number*MS/AR/MPA Number or Call Number*Box Number or Page Number (if applicable)Folder Number (if applicable)Address (URL) of Image File Requested*Ex. http://diglib.lib.utk.edu/image1Image or Collection Name*Format NeededLow Resolution Scan - $3.00High Resolution Scan (400 dpi minimum) - $10.00Black and White Print (2.5 feet x 2 feet) - $2.50Black and White Print (2.5 feet x 3 feet) - $3.75Black and White Print (2.5 feet x 4 feet) - $5.00Black and White Print (2.5 feet x 5 feet) - $6.25Black and White Print (3 feet x 2 feet) - $3.00Black and White Print (3 feet x 3 feet) - $4.50Black and White Print (3 feet x 4 feet) - $6.00Black and White Print (3 feet x 5 feet) - $7.50B&W Printing - Price: 50 cents sq. ft. Please select the option that best fits your desired size.Hign Resolution Scan Price: $10.00 Format NeededLow Resolution Scan - $3.00High Resolution Scan (400 dpi minimum) - $10.00Item Requested - 5Author*Title*Date*Publisher*Publication Date*Call Number*MS/AR/MPA Number or Call Number*Box Number or Page Number (if applicable)Folder Number (if applicable)Address (URL) of Image File Requested*Ex. http://diglib.lib.utk.edu/image1Image or Collection Name*Format NeededLow Resolution Scan - $3.00High Resolution Scan (400 dpi minimum) - $10.00Black and White Print (2.5 feet x 2 feet) - $2.50Black and White Print (2.5 feet x 3 feet) - $3.75Black and White Print (2.5 feet x 4 feet) - $5.00Black and White Print (2.5 feet x 5 feet) - $6.25Black and White Print (3 feet x 2 feet) - $3.00Black and White Print (3 feet x 3 feet) - $4.50Black and White Print (3 feet x 4 feet) - $6.00Black and White Print (3 feet x 5 feet) - $7.50B&W Printing - Price: 50 cents sq. ft. Please select the option that best fits your desired size.Hign Resolution Scan Price: $10.00 Format NeededLow Resolution Scan - $3.00High Resolution Scan (400 dpi minimum) - $10.00Additional InformationPlease add any additional information you feel is relevant to completing your requestMaterials will be published in:TitlePublisherPublication DateTerms of UseConditions for Materials Use Statement The University of Tennessee, Knoxville - Libraries (UT Libraries) claims only physical ownership of most material in the collections. Persons wishing to broadcast or publish this material must assume all responsibility for identifying and satisfying any claimants of copyright. UT Libraries in no way waives its right to future publication of the image(s) supplied to you or the right to grant others permission to use them. The recipient agrees to indemnify and hold harmless the University of Tennessee, its officers, employees and agents from and against all suits, claims, actions and expenses arising out of the use of reproductions provided by the UT Libraries. Images must be properly credited: "[Identification of Item], [Collection Name] [Collection Number, if applicable]. University of Tennessee, Knoxville - Libraries" UT Libraries reserves the right to restrict the use and reproduction of rare, valuable, or fragile materials. In general, duplication of entire books or collections is not permissible. Images for Web use may not be published at more than 72 DPI. UT Libraries encourages the researcher to provide this repository with one complimentary copy of the finished work. Usage Agreement* I have read and agree to the materials usage rights statement Scanning FeesHandling Fee $10.00 Total $0.00 UT students, faculty and staff, please disregard the payment total. There is no charge for your scans. Library staff will contact you if you have reached your 10 scan per semester limit.There is no fee to digitize University of Tennessee, Knoxville theses and dissertations. Please allow about one week for order requests to be completed.Send payment to: University of Tennessee Libraries 171 Hodges Library 1015 Volunteer Blvd. Knoxville, TN 37996-1000 Checks or money order only, made to “University of Tennessee”. Please allow about one week for order requests to be completed after payment is received.Check or money order only, made to “University of Tennessee”. Most orders (under 10 items) can be completed the next business day. Please contact Jeff French (865) 974-6214 jfrench4@nullutk.edu with any questions.Please note that for Special Collections material, fees are per page scan, not collection. Price may change based on final page count. Send payment to: University of Tennessee Libraries 120 Hodges Library 1015 Volunteer Blvd. Knoxville, TN 37996-1000 Checks or money order only, made to “University of Tennessee”. Please allow 3-4 weeks for order requests to be completed after payment is received.