How Do I Get Permission?
(Use
Contact Name Date:
Company Address
Phone/Fax/Email
Dear______________:
I request permission to use the following material:
Nature of material (circle one): book chapter, journal articles, thesis, video, CD-ROM, Diskette, DVD,
Other (Describe):
Author(s):
Title of Material:
Date of Publication: Volume/Issue (if applicable): Page numbers:
A photocopy of the material is enclosed.
I Hereby Seek Your Permission to Use the Above Material in the Following Manner: (circle):
Digital Hardcopy Other (explain):
IF for class:
Name of class:
Current class size:
Number of sections:
The material will be (circle one):
Kept by the student
Returned to the instructor
Dates/Duration of use:
Unless you specify otherwise, the material will be accompanied with the following copyright notice:
Notice: This material may be protected
By copyright law (TITLE 17,
If you do not control the world rights to the requested material, please specify here any additional source from whom permission must be obtained:
Thank you for your prompt consideration of this request. For your convenience, a release form is provided below.
Sincerely,
(your signature and address)
RELEASE FORM:
Permission is granted for the use requested above.
Permission is not granted for the use requested above, for the following reason(s):
_________________________ _________________________
Signature Date
Title_____________________ Institution _________________________
Fax#/Phone/Email____________________________________________________
