[Insert: Today’s Date and Your Address and Contact Information]
Name and Address of Addressee
Dear ______________________________:
I am requesting permission to reprint [a portion of] the following work:
[Add here full citation information about the work, including author, title, publisher, date of publication, exact pages you are requesting, and any other identifying information; include similar information about a book, motion picture, photograph, music, or any other type of work you might want to use.]
This request is for permission to include the above content on my university’s course management system, known as <Replace -Your LMS> here at the <Replace - Institution Name>. The materials are currently hosted on a “cloud” server, and they are accessible only to registered students with username and password access to the system.
I believe that you/your company, __________, are/is currently the holder of the copyright, because the
original work states that copyright is held in your name/the name of the publisher, and my research
indicates that ________________ [additional reason you think this person/company owns the
copyright]. If you do not currently hold the rights, please provide me with any information that can
help me contact the proper rights holder. Otherwise, your permission confirms that you hold the right
to grant this permission.
This request is for a non-exclusive, irrevocable, and royalty-free permission, and it is not intended to
interfere with other uses of the same work by you. I hope that you will support our educational
programs by granting this permission. I would be pleased to include a full citation to the work and
other acknowledgement as you might request.
I would greatly appreciate your permission. If you require any additional information, do not hesitate
to contact me at the address, email address or number above.
Optional: A duplicate copy of this request has been provided for your records. If you agree with the terms as described above, please sign the letter where indicated below and return one copy in the enclosed return envelope.
Sincerely,
Permission is hereby granted:
Signature: ___________________________ Name & Title: _______________________
Company/Affiliation: ______________________________ Date: __________________
Used with permission: Revised: 09/04/2014 www.copyright.columbia.edu
TOPKit Sample Course created by Sue Bauer, John Raible, and Jessica Tojo. This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.