Sample faculty permission letter…Insert your own letterhead or logo here.
Request for Copyright Permission to use material in digital formats for educational purposes
Date:
Rights holder information:
Rights holder name:
Fax number:
Telephone:
Email address:
Mailing address:
I request permission to use the following material in a digital format for educational purposes. The
material will be made available to students via _______________________________________________
Describe how you will deliver the material:
_____________________________________________________________________________________
i.e. Blackboard, public website, CD-ROM
____________________________________________________________________________________.
Information about the material:
To add more materials,
Type of material
Book, journal or other printed material
Music
copy and paste this table
(check one):
Video/DVD
Images or graphics
on another page
Other, please specify:
Type of digital use
Scanned
Streamed
(check one):
Other, please specify:
Title:
Author:
Date of Publication
or Edition:
Specific pages/parts
to be used:
ISBN, ISSN or other
applicable ID number:
Journal Volume and
Issue:
Check whichever are applicable, if any:
I will be adopting this textbook as a required text for my course.
Yes
No
Ryerson University subscribes to this journal.
Yes
No
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Sample faculty permission letter…Insert your own letterhead or logo here.
Information about the users:
Course Code:
Number of Students:
Course Name:
Course Start Date:
Course End Date:
Information about the requestor:
Name:
Title:
Department:
Telephone:
Fax:
E-mail:
Mailing address:
Thank you in advance for your prompt consideration of this request—we would appreciate a response by
this date: _________. Please reply using the requestor’s contact information given above.
Sincerely,
______________________
(Signature of Requestor)
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