Sample AS&E Publisher Permission Letter

The following may be used as a template when requesting publisher permission for using copyrighted material not covered by fair use. Please print on Tufts stationery. Retain copies of all publisher permission letters sent and all publisher responses for your files.

Dear Permissions Editor:

I am writing to request permission to place photocopy(ies) on reserve in Tisch Library for my course (see details below). Tufts University School of Arts, Sciences & Engineering is a non-profit institution of higher education.

Citation of item for which permission is being requested:
Journal or book title:
Journal issue or book edition:
Copyright or publication date:
Author's full name:
Article title or book chapter:
Pages:

Course information where material will be used:
Name and number of academic course:
Name of instructor:
Class size:             Number of Photocopies to be made:
Semester/year course will be given:
Will item be assigned in future semesters? _____Yes _____No

Thank you for your prompt consideration of this request. Please return the permission requested in the enclosed self addressed envelope. If you are not the copyright holder or do not have authority to grant this request, I would appreciate any information you can provide concerning the current copyright holder from whom permission must be obtained:

_____ Check here if the above request is approved and indicate any conditions:______________________________________________________________.

Indicate here if photocopies can be used for this course in the future without re-requesting
permission: _____Yes _____No

If there is a fee for usage, supply this information here____________________________.

Thank you very much for your response to this request.
Signature:
Printed name and title:
Date: