PRIVACY ACT ADVISORY STATEMENT Required by the Privacy Act of 1974 (P.L. 93-579)
The authority for requesting this information is title 17 U.S.C. §409 and §410. Furnishing the
requested information is voluntary. But if the information is not furnished, it may be necessary to
delay or refuse registration and you may not be entitled to certain relief, remedies, and benets
provided in chapters 4 and 5 of title 17 U.S.C. The principal uses of the requested information are
the establishment and maintenance of a public record and the examination of the application for
compliance with lthe registration requirements of the copyright code. Other routine uses include
public inspection and copying, preparation of public indexes, preparation of public catalogs of
copyright registrations, and preparation of search reports upon request.
NOTE: No other advisory statement will be given in connection with this application. Please keep
this statement and refer to it if we communicate with you regarding this application.
BASIC INFORMATION
4
Form SE
Detach and read these instructions before completing this form.
Make sure all applicable spaces have been filled in before you return this form.
Please type or print using black ink. The form is used to produce the certificate.
LINE-BY-LINE INSTRUCTIONS
When to Use This Form: Use a separate Form SE for registration of each
individual issue of a serial. A serial is defined as a work issued or intended to
be issued in successive parts bearing numerical or chronological designations
and intended to be continued indefinitely. This class includes a variety of works,
such as periodicals; newspapers; annuals; and the journals, proceedings, and
transactions of societies. Do not use Form SE to register an individual contribu-
tion to a serial. Go to www.copyright.gov to register such contributions.
Deposit to Accompany Application: An application for copyright registration
must be accompanied by a deposit consisting of copies or phonorecords rep-
resenting the entire work for which registration is to be made. The following
are the general deposit requirements as set forth in the statute:
Unpublished Work: Deposit one complete copy (or phonorecord).
Published Work: Deposit two complete copies (or one phonorecord) of
the best edition.
Work First Published Outside the United States: Deposit one complete
copy (or phonorecord) of the first foreign edition.
Mailing Requirements: You must send the application, the deposit copy or
copies, and the registration fee together in the same envelope or package to
the address in space 9. The Copyright Office cannot process them unless they
are received together.
The Copyright Notice: Before March 1, 1989, the use of copyright notice was
mandatory on all published works, and any work first published before that
date should have carried a notice. For works first published on and after March
1, 1989, use of the copyright notice is optional. For more information about
copyright notice, see Circular 3, Copyright Notices.
For Further Information: To speak to a Copyright Office staff member, call
(202) 707-3000 or 1-877-476-0778. Recorded information is available 24 hours
a day. Register online and access circulars and all copyright application forms
from the Copyright Office website at www.copyright.gov. Or, request publica-
tions from the Forms and Publications Hotline at (202) 707-9100. Leave a
recorded message. To send an email communication, click on Contact Us at
the bottom of the homepage.
1
SPACE 1: Title
Title of This Serial: Every work submitted for copyright registration
must be given a title to identify that particular work. If the copies or phono-
records of the work bear a title (or an identifying phrase that could serve as a
title), copy that wording completely and exactly on the application. Give the
volume and number of the periodical issue for which you are seeking registra-
tion. The “Date on Copies in space 1 should be the date appearing on the
actual copies (for example: “June 1981, “Winter 1981”). Indexing of the regis-
tration and future identification of the work will depend on the information
you give here.
Previous or Alternative Titles: Complete this space only if there are any ad-
ditional titles for the serial under which someone searching for the registration
might be likely to look or under which a document pertaining to the work
might be recorded.
2
SPACE 2: Author(s)
General Instructions: After reading these instructions, decide who
are the “authors” of this work for copyright purposes. In the case of a serial
issue, the organization that directs the creation of the serial issue as a whole
is generally considered the author of the collective work” (see “Nature of Au-
thorship) whether it employs a staff or uses the efforts of volunteers. Where,
however, an individual is independently responsible for the serial issue, name
that person as author of the collective work.
Name of Author: The fullest form of the author’s name should be given. In
the case of a “work made for hire, the statute provides that “the employer or
other person for whom the work was prepared is considered the author. If this
issue is a “work made for hire, the author’s name will be the full legal name
of the hiring organization, corporation, or individual. The title of the periodi-
cal should not ordinarily be listed as “author” because the title itself does not
usually correspond to a legal entity capable of authorship. When an individual
creates an issue of a serial independently and not as an employee of an orga-
nization or corporation, that individual should be listed as the “author.
Author’s Nationality or Domicile: Give the country of which the author is a
citizen, or the country in which the author is domiciled. Nationality or domicile
must be given in all cases. The citizenship of an organization formed under
U.S. federal or state law should be stated as “U.S.A.
What Is a “Work Made for Hire”? A “work made for hire is defined as (1) “a
work prepared by an employee within the scope of his or her employment”;
or (2) “a work specially ordered or commissioned for use as a contribution to
a collective work, as a part of a motion picture or other audiovisual work, as
a translation, as a supplementary work, as a compilation, as an instructional
text, as a test, as answer material for a test, or as an atlas, if the parties expressly
agree in a written instrument signed by them that the work shall be considered
a work made for hire. An organization that uses the efforts of volunteers in
the creation of a collective work (see “Nature of Authorship”) may also be
considered the author of a “work made for hire” even though those volunteers
were not specifically paid by the organization. In the case of a “work made for
hire, give the full legal name of the employer and check “Yes” to indicate that
the work was made for hire. You may also include the name of the employee
along with the name of the employer (for example: “Elster Publishing Co.,
employer for hire of John Ferguson).
Anonymous” or “Pseudonymous” Work: Leave this space blank if the serial
is a “work made for hire. An author’s contribution to a work is anonymous”
if that author is not identified on the copies or phonorecords of the work. An
author’s contribution to a work is “pseudonymous” if that author is identified
on the copies or phonorecords under a fictitious name. If the work is “anony-
mous, you may: (1) leave the line blank; or (2) state anonymous” on the line;
or (3) reveal the author’s identify. If the work is “pseudonymous, you may:
(1) leave the line blank; or (2) give the pseudonym and identify it as such (for
example: “Huntley Haverstock, pseudonym); or (3) reveal the author’s name,
making clear which is the real name and which is the pseudonym (for example:
“Judith Barton, whose pseudonym is Madeline Elster”). However, the citizen-
ship or domicile of the author must be given in all cases.
Dates of Birth and Death: Leave this space blank if the author’s contribution
was a “work made for hire. If the author is dead, the statute requires that the
year of death be included in the application unless the work is anonymous
or pseudonymous. The author’s birth date is optional but is useful as a form
of identification.
Nature of Authorship: Give a brief statement of the nature of the particular
author’s contribution to the work. If an organization directed, controlled, and
supervised the creation of the serial issue as a whole, check the box collective
work. The term “collective work” means that the author is responsible for
compilation and editorial revision and may also be responsible for certain
individual contributions to the serial issue. Further examples of Authorship
that may apply both to organizational and to individual authors are “Entire
text”; Text and illustrations”; “Editorial revision, compilation, and additional
new material.
3
SPACE 3: Creation and Publication
General Instructions: Do not confuse “creation with “publication.
Every application for copyright registration must state “the year in which cre-
ation of the work was completed. Give the date and nation of first publication
only if the work has been published.
Creation: Under the statute, a work is “created” when it is fixed in a copy or
phonorecord for the first time. Where a work has been prepared over a pe-
riod of time, the part of the work existing in fixed form on a particular date
constitutes the created work on that date. The date you give here should be
the year in which this particular issue was completed.
Publication: The statute defines “publication as “the distribution of copies or
phonorecords of a work to the public by sale or other transfer of ownership
or by rental, lease, or lending”; a work is also “published” if there has been an
offering to distribute copies or phonorecords to a group of persons for pur-
poses of further distribution, public performance, or public display. Give the
full date (month, day, year) when, and the country where, publication of this
particular issue first occurred. If first publication took place simultaneously in
the United States and other countries, it is sufficient to state “U.S.A.
4
SPACE 4: Claimant(s)
Name(s) and Address(es) of Copyright Claimant(s): This space must
be completed. Give the name(s) and address(es) of the copyright claimant(s)
of this work even if the claimant is the same as the author named in space 2.
Copyright in a work belongs initially to the author of the work (including, in
the case of a work made for hire, the employer or other person for whom the
work was prepared). The copyright claimant is either the author of the work
or a person or organization to whom the copyright initially belonging to the
author has been transferred.
Transfer: The statute provides that, if the copyright claimant is not the author,
the application for registration must contain “a brief statement of how the
claimant obtained ownership of the copyright. If any copyright claimant
named in space 4 is not an author named in space 2, give a brief statement
explaining how the claimant(s) obtained ownership of the copyright. Examples:
“By written contract”; “Transfer of all rights by author”; Assignment”; “By
will. Do not attach transfer documents or other attachments or riders.
5
SPACE 5: Previous Registration
General Instructions: This space rarely applies to serials. Complete
space 5 if this particular issue has been registered earlier or if it contains a
substantial amount of material that has been previously registered. Do not
complete this space if the previous registrations are simply those made for
earlier issues.
Previous Registration:
a. Check this box if this issue has been registered in unpublished form and a
second registration is now sought to cover the first published edition.
b. Check this box if someone other than the author is identified as copyright
claimant in the earlier registration and the author is now seeking registration
in his or her own name. If the work in question is a single contribution to a
collective work as opposed to the issue as a whole, do not file Form SE. Instead,
register the contribution on the Copyright Office website at www.copyright.
gov, or request Form TX from the Copyright Office.
c. Check this box (and complete space 6) if this particular issue or a substantial
portion of the material in it has been previously registered and you are now
seeking registration for the additions and revisions that appear in this issue
for the first time.
Previous Registration Number and Date: Complete this line if you checked
one of the boxes above. If more than one previous registration has been made
for the issue or for material in it, give only the number and year date for the
latest registration.
6
SPACE 6: Derivative Work or Compilation
General Instructions: Complete space 6 if this issue is a “changed
version, “compilation, or “derivative work” that incorporates one or more
earlier works that have already been published or registered for copyright or
that have fallen into the public domain. Do not complete space 6 for an issue
consisting of entirely new material appearing for the first time, such as a new
issue of a continuing serial. A “compilation is defined as “a work formed
by the collection and assembling of preexisting materials or of data that are
selected, coordinated, or arranged in such a way that the resulting work as a
whole constitutes an original work of authorship. A “derivative work” is “a
work based on one or more preexisting works. Examples of derivative works
include translations, fictionalizations, abridgments, condensations, or “any
other form in which a work may be recast, transformed, or adapted. Deriva-
tive works also include works “consisting of editorial revisions, annotations,
or other modifications” if these changes, as a whole, represent an original
work of authorship.
Preexisting Material (space 6a): For derivative works, complete this space
and space 6b. In space 6a identify the preexisting work that has been recast,
transformed, adapted, or updated. Example: “1978 Morgan Co. Sales Catalog.
Do not complete space 6a for compilations.
Material Added to This Work (space 6b): Give a brief, general statement of the
new material covered by the copyright claim for which registration is sought.
Derivative work examples include: “Editorial revisions and additions to the
Catalog”; Translation”; Additional material. If a periodical issue is a com
-
pilation, describe both the compilation itself and the material that has been
compiled. Examples: “Compilation of previously published journal articles”;
“Compilation of previously published data. An issue may be both a derivative
work and a compilation, in which case a sample statement might be: “Compila
-
tion of [describe] and additional new material.
7,8,9
SPACE 7,8,9: Fee, Correspondence,
Certication, Return Address
Deposit Account (space 7a): If you maintain a deposit
account in the Copyright Office, identify it in space 7a. Otherwise leave the
space blank and send the fee with your application and deposit.
Correspondence (space 7b): This space should contain the name, address,
area code, telephone and fax numbers, and email address of the person to be
consulted if correspondence about this application becomes necessary.
Certification (space 8): The application cannot be accepted unless it bears the
date and the signature of the author or other copyright claimant, or the owner
of exclusive right(s), or the duly authorized agent of the author, claimant, or
owner of exclusive right(s).
Address for Return of Certificate (space 9): The address box must be com-
pleted legibly because the certificate will be returned in a window envelope.
DO NOT WRITE ABOVE THIS LINE. IF YOU NEED MORE SPACE, USE A SEPARATE CONTINUATION SHEET.
1
4
TITLE OF THIS SERIAL
Volume Number Date on Copies Frequency of Publication
PREVIOUS OR ALTERNATIVE TITLES
COPYRIGHT CLAIMANT(S) Name and address must be given even if the claimant is the same as the author
given in space 2.
TRANSFER If the claimant(s) named here in space 4 is (are) different from the author(s) named in space 2, give a
brief statement of how the claimant(s) obtained ownership of the copyright.
MORE ON BACK
DO NOT WRITE HERE
Page 1 of pages
Complete all applicable spaces (numbers 5–9) on the reverse side of this page.
• See detailed instructions. • Sign the form at line 8.
DO NOT WRITE HERE
OFFICE USE ONLY
See instructions
before completing
this space.
APPLICATION RECEIVED
ONE DEPOSIT RECEIVED
TWO DEPOSITS RECEIVED
FUNDS RECEIVED
Form SE
3
For a Serial
UNITED STATES COPYRIGHT OFFICE
REGISTRATION NUMBER
U
EFFECTIVE DATE OF REGISTRATION
Month Day Year
Collective Work Other:
Copyright Ofce fees are subject to change. For
current fees, check the Copyright Ofce website
at
www.copyright.gov,
write the Copy right Ofce,
or call (202) 707-3000 or 1-877-476-0778.
Privacy Act Notice: Sections 408-410 of title 17 of the
United States
Code
authorize the Copyright Ofce to collect the personally identifying
information requested on this form in order to process the applica-
tion for copyright registration. By providing this information you are
agreeing to routine uses of the information that include publication
to give legal notice of your copyright claim as required by 17 U.S.C.
§705. It will appear in the Ofce’s online catalog. If you do not provide
the information requested, registration may be refused or delayed,
and you may not be entitled to certain relief, remedies, and benets
under the copyright law.
3
2
YEAR IN WHICH CREATION OF THIS
WORK WAS COMPLETED
This information
must be given
in all cases.
DATE AND NATION OF FIRST PUBLICATION OF THIS PARTICULAR WORK
Complete this information
ONLY if this work
has been published.
Year
ba
Month Day Year
Nation
NAME OF AUTHOR DATES OF BIRTH AND DEATH
Year Born Year Died
NOTE
Under the law,
the “author” of
a “work made
for hire” is
generally the
employer, not
the employee
(see instruc-
tions). For any
part of this
work that was
“made for hire”
check “Yes” in
the space
provided, give
the employer
(or other
person for
whom the work
was prepared)
as “Author” of
that part, and
leave the
space for dates
of birth and
death blank.
Name of Country
Citizen of
Domiciled in
{
Was this contribution to the work a
“work made for hire”?
OR
AUTHOR'S NATIONALITY OR DOMICILE
WAS THIS AUTHOR’S CONTRIBUTION TO
THE WORK
Anonymous? Yes No
Pseudonymous?
Yes No
If the answer to either
of these questions is
“Yes,” see detailed
instructions.
NATURE OF AUTHORSHIP Briey describe nature of material created by this author in which copyright is claimed.
a
NAME OF AUTHOR DATES OF BIRTH AND DEATH
Year Born Year Died
Name of Country
Citizen of
Domiciled in
{
Was this contribution to the work a
“work made for hire”?
OR
AUTHOR'S NATIONALITY OR DOMICILE
WAS THIS AUTHOR’S CONTRIBUTION TO
THE WORK
Anonymous? Yes No
Pseudonymous?
Yes No
If the answer to either
of these questions is
“Yes,” see detailed
instructions.
NATURE OF AUTHORSHIP Briey describe nature of material created by this author in which copyright is claimed.
b
NAME OF AUTHOR DATES OF BIRTH AND DEATH
Year Born Year Died
Name of Country
Citizen of
Domiciled in
{
Was this contribution to the work a
“work made for hire”?
OR
AUTHOR'S NATIONALITY OR DOMICILE
WAS THIS AUTHOR’S CONTRIBUTION TO
THE WORK
Anonymous? Yes No
Pseudonymous?
Yes No
If the answer to either
of these questions is
“Yes,” see detailed
instructions.
NATURE OF AUTHORSHIP Briey describe nature of material created by this author in which copyright is claimed.
c
Yes
No
Yes
No
Yes
No
DEPOSIT ACCOUNT If the registration fee is to be charged to a deposit account established in the Copyright Office, give name and number of account.
Name Account Number
CORRESPONDENCE Give name and address to which correspondence about this application should be sent. Name/Address/Apt/City/State/Zip
of the work identified in this application and that the statements made
by me in this application are correct to the best of my knowledge.
Typed or printed name and date If this application gives a date of publication in space 3, do not sign and submit it before that date.
Area code and daytime telephone number Fax number
Email
author
other copyright claimant
owner of exclusive right(s)
authorized agent of
Name of author or other copyright claimant, or owner of exclusive right(s)
9
Date
DERIVATIVE WORK OR COMPILATION Complete both space 6a and 6b for a derivative work; complete only 6b for a compilation.
Preexisting Material Identify any preexisting work or works that this work is based on or incorporates.
Material Added to This Work Give a brief, general statement of the material that has been added to this work and in which copyright is claimed.
5
6
EXAMINED BY
CHECKED BY
CORRESPONDENCE
Yes
FORM SE
FOR
COPYRIGHT
OFFICE
USE
ONLY
DO NOT WRITE ABOVE THIS LINE. IF YOU NEED MORE SPACE, USE A SEPARATE CONTINUATION SHEET.
PREVIOUS REGISTRATION
Has registration for this work, or for an earlier version of this work, already been made in the Copyright Office?
Ye s No If your answer is “Yes,” why is another registration being sought? (Check appropriate box.)
a.
This is the first published edition of a work previously registered in unpublished form.
b.
This is the first application submitted by this author as copyright claimant.
c.
This is a changed version of the work, as shown by space 6 on this application.
If your answer is “Yes, give: Previous Registration Number Year of Registration
Name
Number/Street/Apt
City/State/Zip
*17 U.S.C. §506(e): Any person who knowingly makes a false representation of a material fact in the application for copyright registration provided for by section 409, or in any written statement led in connection
with the application, shall be ned not more than $2,500.
See instructions
before completing
this space.
Signature
7
8
CERTIFICATION* I, the undersigned, hereby certify that I am the
{
YOU MUST:
• Complete all necessary spaces
• Sign your application in space 8
SEND ALL 3 ELEMENTS
IN THE SAME PACKAGE:
1. Application form
2. Nonrefundable ling fee in check or money
order payable to U.S. Copyright Ofce
3. Deposit material
MAIL TO:
Library of Congress
U.S. Copyright Ofce-SE
101 Independence Avenue SE
Washington, DC 20559-6000
a
b
Check only one
a
b
Certicate
will be
mailed in
window
envelope
to this
address:
Form SE–Full Reviewed: 05 / 2019 Printed on recycled paper U.S. Government Printing Ofce: 2019-xxx-xxx/xx,xxx