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Section 1: Contact Information
Section
2: State the title and previous or alternative title(s) of
the work (if any).
Title
Previous or
Alternative Title(s)
Section 3:
In What Year was the Work Created?
Year
Section 4:
State the name(s), citizenship(s) and date(s) of birth
for the creator(s) of the work.
Author #1
Author #2
Section 5:
Identify the nature of each author's contributions to
the work.
Author #1
Author #2
Section 6:
If you are not the author of the work but you are
claiming copyright, briefly state the basis of your
claim.
Section 7:
Is your work is based on any pre-existing material or
does it include any pre-existing material? If so,
identify the pre-existing material and explain how your
work differs.
Pre-existing
material
Difference from
your work
Section 8:
If the material has been published or publicly
distributed, please give the date of the first
publication or earliest distribution and the nation of
the first publication or earliest distribution.
Date of first
publication or earliest distribution
Section 9:
Was the work created in the course of employment? If so,
explain.
Section 10:
Has this material, or an earlier version, been
previously registered in the Copyright Office? If so,
explain.
Previous
Registration Number
Year of
Previous Registration
Section 11:
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