Fill and Sign the How to Write Request Letter for Permission Form

Your Name Address Date Permissions Dept. or Author' name Address Subject: Requested permission to use copyrighted material for class Dear , I am writing to request permission to copy the following works for use in a course I am teaching. Although use of this material pursuant to the “Fair Use Doctrine” of Section 107 of Title 17 U.S.C, the Copyright Act, permits reproduction or use of another’s work for educational purposes, I realize that there are no definitive rules granting a user unfettered use of another’s copyrighted work. If you do not have the ability to grant these rights, I would appreciate any information on who could. I have enclosed a self addressed stamped envelope and attached a “PERMISSION GRANTED” form for you to sign and send back for your convenience. The following is the information that I wish to use: Item Information Name of author/editor/translator: Title: Edition: Volume Number: ISBN/ ISSN: Page Numbers to be used: Number of exact pages, figures and illustrations: Reproduction Information Material will be used alone combined with other photocopied material Number of copies to be produced: Method of reproduction (photocopy, scanning, etc.): Method of distribution (reserve, blackboard, etc.): Course Information Instructor’s Name: Address: Phone: email: Contact Name: Name of School or Institution: Department: Course Name and Number: Semester and Year in which material will be used: Would like to use for more than one semester Yes No Additional Information: Thank you for your prompt attention to this matter. Your material will be welcomed as a contributing factor to the success of this course. Please feel free to provide me with any additional comments or suggestions on the enclosed return Permission Form. Sincerely, Your Name C.C. PERMISSION GRANTED FORM I, ________________________, as author/editor/translator hereby grant permission for ______________________ to use the aforementioned works as part of the educational course or curriculum as stated. This does not amount to an assignment, or license but is limited to the purpose described above. By: ______________________ ___________________ Date ______________________ Title