Your Name *

First Name

Last Name

Phone *

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Type of Adaptation Requested (check all that apply): *

Translation (please specify language(s) below)

Local contextualization (e.g., tailoring to specific community, system, or region)

Excerpt/partial use in a larger resource

Format change (e.g., converting to infographic, video, or presentation)

Other

Distribution scope *

Please select all that apply.

Internal to our organization/agency

Local distribution

Statewide distribution

National distribution

Online/public posting

By submitting this request, I acknowledge that: *

Adapted materials must include the following statement: “Adapted with permission from the Oregon Attorney General’s Sexual Assault Task Force. Original work © [Year] Oregon SATF. Adaptations do not necessarily represent the views of Oregon SATF.” I will not use the materials for commercial purposes, political campaigns, or fundraising without written authorization. I will share a copy of the final adapted resource with Oregon SATF for record-keeping.

I agree to these conditions

I do not agree

I have questions and need to speak to an Oregon SATF representative first.

Date

MM

DD

YYYY