Check Sheet
Course Designation __________________________________________
Term Offered ______________________________________________
Instructor Name ____________________________________________
Department _______________________________________________
Address__________________________________________________
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: ____________