Permission Request Form

Instructions

Use of this form is to request permission from Riverside Insights to use its assessment products for certain limited non-commercial purposes, such as research, translation, or adaptation for visually impaired users. If you are seeking to purchase or license Riverside Insights' assessments for use in an educational or clinical program, please do not use this form and instead contact legal@riversideinsights.com.

Riverside Insights' assessment products are subject to copyright and other intellectual property protections and cannot be used for any purpose without the express written consent of Riverside Insights. All rights are reserved by Riverside Insights.

1. Requestor Contact Information

Enter Your Name

Enter Your Email

Enter the Name of Your Organization

Enter the Address of Your Organization

2. Product Information

What Riverside Insights’ Product(s) would you like to use?

If applicable, what version, subtest, edition, or level of the Product(s) do you intend to use?

If known, enter the title # or #s from Riverside Insights’ website or order form.

Date(s) when permission needed by

Date(s) you intend to use the materials

3. Nature of Use

Please select from the drop down options the type of permission you are requesting. You may select multiple options.

Permission Request Form

Instructions

1. Requestor Contact Information

2. Product Information

3. Nature of Use

4. Comments