Reporting Copyright Infringement to Educational Research Service

(Print this form and mail or fax to Educational Research Service)

Copyright Agent
Educational Research Service, Inc.
1001 North Fairfax Street, Suite 500
Alexandria, VA 22314-1587
FAX: (800) 791-9308

This form is only for reporting copyright infringement. If you believe that your work has been copied and is accessible on this service in any way that constitutes copyright infringement, you may notify us by providing us with the following information:

Your Name:______________________________________________________

Your E-mail Address:______________________________________________

Your Mailing Address:_____________________________________________

Your Telephone Number:___________________________________________

Identify the URL, Path or other specific location on the service where the allegedly infringing material is located:______________________________________________________

Describe the allegedly infringed work, including (if available), the URL, Path or other specific location where the copyright work may be found for comparison: _____________________________________________________________________ _____________________________________________________________________

Your relationship to the owner of the allegedly infringed work (e.g., owner, authorized representative):_________________________________________________________

By submitting this complaint, you represent under penalty of perjury, that the above information is accurate, that you are the copyright owner or are authorized to act on the copyright owner's behalf, and that you have a good faith belief that the disputed use is not authorized by the copyright owner, its agent, or the law.

Signature:______________________________________________________

Date:______________________________________________________