<p> Request for Reprint Permission</p><p>Please complete this form and return by: 1) email: [email protected] 2) fax: 001 202-266-1900 or 3) Mail: Migration Policy Institute, c/o Permissions, 1400 16th St. NW, Suite 300, Washington, DC 20036 </p><p>Date: </p><p>Your Name & Title (please print or type): </p><p>Name of company or organization requesting permission: Contact person’s E-mail: Phone Number: Fax: Website:</p><p>Address 1: Address 2: City: State/Province: Postal Code: Country: </p><p>USA Payee—Tax ID number: Non-USA Payee—W8-BEN number:</p><p>Request to reprint the following Migration Policy Institute Publication(s): Article: Title of Publication: Issue details (i.e. Month/Date): Source/URL from MPI/Source website: </p><p>Number of pages in article (please specify only if seeking to reprint a section of a larger publication):</p><p>Title of work in which the MPI material will appear: </p><p>Expected Date of reprint:</p><p>If applicable, language translations (MPI reserves the right to review translations):</p><p>Description of work in which the MPI material will appear or be used: </p><p>Type of Media: ____ Electronic (specify type (PowerPoint, Broadcast type, etc) : ______) ____ Website link (specify URL which MPI link or article will appear:______) ____ Course reader (Professor ______, Semester______Course name______, Approx.# of copies ______)</p><p>____ Publication (specify :______) Print Run ______Sales Price ______ISBN: ______</p><p>FOR INTERNAL USE [ ] fee assessed $______Invoice/Permissions Tracking #______</p>