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Sample Request for Permission to Duplicate Print Material

Use College letterhead stationery.


Permission Department
Parrot Press
123 Zebra
Ann Arbor, MI 12345
Dear Sir or Madam:
As a faculty member of Central Virginia Community College, a nonprofit higher education institution of the Commonwealth of Virginia, I would like permission to duplicate the following for use in next semester’s class beginning {INSERT DATE} and ending {INSERT DATE}.
Title:                                                  HANDBOOK FOR WRITERS
Edition:                                              3rd
Copyright:                                         Parrot Press, 2001
Author:                                              Glenn H. Leggett
Material to be duplicated:                 Pages 26 - 30 (photocopies enclosed), all in Chapter 2
Number of copies:                            26
Distribution:                                     English Composition I classroom; the material will be distributed free to  
Type of reprint:                                Photocopy
The pages listed will be used as supplementary materials for the class. 

A self-addressed envelope is enclosed for your convenience.  Please reply by _______. 

Please let me know what your fee will be for this permission.


Alice Jones, Assistant Professor
Humanities Division
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