Check Sheet

Course Designation __________________________________________
Term Offered ______________________________________________
Instructor Name ____________________________________________
Department _______________________________________________
Phone ___________________________________________________
Email ___________________________________________________

As the responsible instructor, I grant permission for electronically recording of my lectures in the above course on the following basis: 

__  All lectures
__  Audio only                 __ Video Only               __ Both audio and video

Archiving of recordings:

__ Unlimited time duration of archiving
__ Time limited archiving only(circle one)​​​​​​:

  • One Semester
  • One Year
  • Other ___________

__ Restricted-access archiving only

Note: Any additional restrictions must be defined in writing to the University Archivist.

Signature: __________________________________   Date: ____________