Permission to use writing for training and research purposes

Your name (please print):									

I understand and agree that my instructor, __________________, may use samples of my writing for training or research purposes only, with the provision that my name will be removed from any writing sample and that I will not be identified in any other way, in the text or otherwise. I further understand that I may withdraw this permission at any time by emailing or writing to ______________ at ___________@iwu.edu . 

	   I agree to the terms above.

	   I decline the terms above.

Your signature: 								

Date:				

Permission to use writing for training and research purposes

Your name (please print):									

I understand and agree that my instructor, _______________________, may use samples of my writing for training or research purposes only, with the provision that my name will be removed from any writing sample and that I will not be identified in any other way, in the text or otherwise. I further understand that I may withdraw this permission at any time by emailing or writing to ___________ at _______________@iwu.edu . 

	   I agree to the terms above.

	   I decline the terms above.

Your signature: 								

Date: