(Source: www.macalester.edu/~library/copyright/formlet.html)

Return Address
Date of Request

Copyright and Permissions Department
[Name of Publisher]
[Number Street Address]
[City, State Zip Code]

To Whom It May Concern:

I would like permission to copy the following for continued use in my classes in future seminars:

  • Title: Education is the Key to Our Future, 3rd edition
  • Copyright: Your Company, 1995, 1996, 1998
  • Author: Learned B. Sure
  • Material to be copied: Chapter 3
  • Pages: 45-60
  • Number of copies: 20
  • Distribution: This copy will be distributed to students in my classes and they will pay only the costs for photocopying.
  • Type of reprint: Photocopy
  • Use: The chapter will supplement teaching materials.
I have enclosed a copy of the copyright page to assist you in evaluating my request. Please inform me if there are any fees for this permission.

I have also enclosed a stamped, self-addressed envelope for your convenience in responding to my request. Please also note my e-mail address and fax number below.

Sincerely,

[Your Name]
[Phone number]
[Email address]
[Fax number]