Publisher Permission Form

(Copy and paste the sample letter below for your own use!)

Instructions

1. Check with copyright holder's / publisher's web site for information about securing permission.

2. Call ahead to confirm the copyright ownership.

3. Include your return address, telephone number, fax number, and the date at the top of the letter.

4. Clearly state the name of your university and your position.

5. Describe the proposed use of the copyrighted material. If necessary or appropriate, attach a copy of the article, quotations, diagrams, pictures, and other materials. Your objectives are to eliminate any ambiguities and to be sure the permission encompasses the full scope of your needs.

6. The signature form at the end of the sample letter is appropriate when an individual grants the permission. When a company (such as a publishing house) is granting the permission, use the following signature format:

PERMISSION GRANTED FOR THE USE REQUESTED ABOVE:

By:

Date:

 

 

Sample Letter

[letterhead stationery or return address]

Date: ____________________

Name & address of addressee: ____________________

Re: Copyright Permission Request

[If you called first, begin your letter: This letter will confirm our recent telephone conversation.] I am [describe your position] at [name of institution] of the City University of New York. I would like your permission to:

 

  • Option A: _____ Place the cited material in our library's Electronic Course Reserves System in digital image format.1  The class size is _______ .  I anticipate that copies will be placed on reserve for ___ semesters.
OR
  • Option B:_____ Place cited material in the library's print course Reserves collection. The class size is ________ students. I anticipate that copies will be placed on reserve for ____ semesters.


Insert full citation to the original work: ________________________________________

 


Please indicate your approval of this permission by signing the letter where indicated below and returning it to me by fax as soon as possible.

Your signing of this letter will also confirm that you are the sole owner [or your company is the sole owner] of the copyright in the above described material.

 

Thank you very much.

Sincerely,
[Your name, title and signature]

 

------------------------------------------------------------------------------------------------------------
PERMISSION GRANTED FOR THE USE REQUESTED ABOVE:

____________________________________________
[Type name of addressee below signature line]

Date:

 

1Authorization is required for access. Materials are delivered free of charge. The material will be used for not-for-profit, educational purposes only. A copyright compliance statement appears prominently in the system.