Copyright Intake Form
Email
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Please enter your full legal name.
What is the best telephone number for us to use to reach you?
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What type of work is being registered?
Literary Work
Work of the Visual Arts
Sound Recording
Work of the Performing Arts
Motion Picture/AV Work
Single Serial Issue
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What is the title of the work?
Has this work been published?
Yes
No
What is the year of completion (when you finished the work)?
If it has been published, please provide the following information: nation of first publication, date of first publication, International Standard Number and type (e.g. ISBN), if applicable.
Is the author of the work an individual or organization?
Individual
Organization
If the author is an individual, please provide the following information: full legal name, citizenship, nation of residence, year of birth, year of death (if applicable).
If the author is an organization, please indicate the nation in which the organization is based.
Is this author's contribution a work made for hire?
Yes
No
If there are addition authors, whether individuals or organizations, please provide the responses to the above questions in the following space for each additional author.
What was the contribution of each author? Please list for each author: text, computer program, photograph, artwork, or other. If other, please explain.
Is/are the author(s) the claimant(s)? If so, please provide the address for each author. If the claimant is a different party, please provide the following information: name and address of individual or organization and method of transfer (written agreement or inheritance).
Is your work based in part on previous material? If so, what parts of your work were previously registered? Please provide registration information for any previously registered part of this work.
Are there any special circumstances surrounding the registration of this work? E.g. pending litigation, customs matters, contract deadlines that require an expedited timeline. Please explain.
Please provide a copy of the work to be submitted to the Copyright Office.
I hereby affirm that all of the above information is correct to the best of my knowledge (please type your name below).