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Copyright, Fair Use, & Author Rights: Sample Permission letters

More sample forms

Duke University scholarly communications blog: The following sample request for permission letters, release forms and licenses are intended as models. They are not form letters, since each such document should take account of specific situations and circumstances:

Author Addendum

Publisher/copyright Holder Permission Template - replace text in brackets

[Day Month Year

Firstname Lastname, editor or rights holder



Email/snailmail address]


Dear [Title Lastname,]

My name is [Firstname Lastname] and I am writing to you from UC San Diego Library, located at 9500 Gilman Drive #0699, La Jolla, CA 92093-0699[or your institution and address].

I would like permission to include the following material in our institutional repository, eScholarship,

[Citation of material for which permission is sought, specifying exactly what material would be used]

eScholarship is non-commercial and intended for educational purposes. It is meant to reflect the scholarship produced at the University of California campuses by students, faculty and researchers. eScholarship is not password protected and openly accessible on the internet.

If you do not control the copyright on all of the above mentioned material, I would appreciate any contact information you can give me regarding the proper rights holder(s), including current address(es). Otherwise, your permission confirms that you hold the right to grant the permission requested here.

Permission includes permanent non-exclusive world rights to archive, preserve, disseminate and promote the material and will not limit any future publications-including future editions and revisions-by you or others authorized by you.

I would greatly appreciate your consent to my request. If you require any additional information, please do not hesitate to contact me. I can be reached at:

[Your contact information]


[FirstName LastName]




[Phone Number]

Requesting Use

The Association of American Publishers

  • 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 you are requesting a chapter or more, both exact chapter(s) and exact page numbers
  • whether material will be used alone or combined with other photocopied material
  • number of copies to be produced
  • name of college or university
  • course name and number
  • semester and year in which material will be used
  • instructor's full name
  • method of reproduction (photocopying, scanning, etc.)

Getting Your Rights Back