Sample Permission Request


Date: xx/xx/xx

To: Attn: Permissions Department
Publisher’s name and address

From: Name, department, contact info

Dear permissions editor:

I am writing to request permission to reprint material from the following publication:
Book: Include title, author, copyright date and owner (publisher)
Journal: Include title, editor, volume number, issue, and year
Artwork: Title, artist

Description of reprint material:
Figure numbers, chapter titles, page numbers, author, artist, etc.

Description of the intended use:
-What is your use and distribution? Is it for a syllabus, coursepack, multimedia project, reserve, handouts, etc? Is it appearing in electronic and/or print format?
-Is the purpose educational, non-profit, or commercial? Are you charging money for these materials? It usually helps to emphasize the fact that you are not making any money as a result of using the material.
-Length of time you will use the material?
-How many copies distributed? If on web: How many people will access site?
-Any additional protective measures employed (eg. passwords, further limiting access to only small portion of the password population, watermarked images, etc)?

If for some reason you do not own the copyright for these materials, I would appreciate any information you can provide concerning the proper person or company with whom I should inquire.

Please respond in writing to indicate whether permission is granted and inform me of any fees or conditions that may be required. In addition to the terms of agreement, please also indicate how you wish to be credited.

Thank you for your time and consideration of this request. I look forward to hearing back from you at your earliest convenience.


Title, School

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