Internal Licensing Approval Form

 

Request for Usage of Alcorn State University's Trademarks, Logos or Marks

Registered Student Organization/Department:          
Organization's Name:   
Sponsor's Name:   
    E-mail:   
    Phone Number:   
Organization's Contact Person:   
    E-mail:   
    Phone Number:   
    Fax Number:   
Address:      
City:    State:  Zip: 
 
Grants & Contracts: 
  
Date: 
  


 
Reason:   
 
Product will be: (Check all that apply)
 
  
    If other, please describe:   
 
 If product is sold, proceeds will be used for:
(Check all that apply)
 
  
    If other, please describe: 
 
Artwork/Product Description:   
 
    Quantity:
 
 
 
    Please list product color(s):    
Note:  include a copy of the artwork for approval.  


Vendor Information 
 
Name of Licensed Vendor:   
Contact Name:   
Phone:   
E-mail: