Copyright Resources for Huntington University: Permission Request Form

If you cannot justify Fair Use for the use of copyrighted materials you must request permission from the copyright holder. 

Copyright permission can be obtained via Copyright Clearance Center, the publisher, or copyright holder.  Feel free to contact a Librarian for assistance. 

For further information please click on the link below.

[Date and Complete Contact Information]

[Name]                                                                                               

[Department]                                                                                  

[University, etc.]                                                                             

[Other contact information]                                                         

Name and Address of Addressee

Dear                                                      :

I would like to request permission to (reprint/use) the following work: (Bullet points from the Huntington University Faculty Handbook, 2012, A-16)

• author’s, editor’s, translator’s full name(s)

• title, edition and volume number of book or journal

• copyright date

• ISBN for books, ISSN for magazines and journals

• numbers of the exact pages, figures and illustrations

• if requesting a chapter or more: both exact chapters and exact page numbers

• number of copies to be made

• whether material will be used alone or combined with other photocopied materials

• Huntington University, course number and course title

• semester and year for which material will be used

• instructor’s full name

I would like to use this work on my university’s Course Management System, Moodle.  The CMS is housed on the university server and is password protected; only my students will be able to access this work for the duration of the semester/class.

Through my research it apparent that you/your company,                                           are/is currently the copyright holder of this work.  If you currently do not hold the copyright, I would appreciate it if you could provide me with information so that I can contact the correct holder. 

I am requesting non-exclusive, irrevocable, and royalty-free permission to use this work. I will include the citation for your work as well as any other acknowledgement you might request.

If you need further information from me please contact me through the above information. I would greatly appreciate the privilege of using your work to further the education of my students.

If you are able to grant permission based on the terms stated in this letter please sign the permission line below and return this letter either scanned to email or in the enclosed envelope.

Thank you for your consideration.

Sincerely,

Permission to use [copy the identifying information here] is hereby granted:

Signature:                                                                                                                        

Name & Title:                                                                                                                  

Company/Affiliation:                                                                                                      

Date:                                                                                    

 ~~~~ ALWAYS take care to keep a copy of the permission slip ~~~~