SAMPLE PERMISSION REQUEST LETTER AND FORM
[Adapt this letter in the bracketed areas to send out under your own letterhead with the accompanying form. At the top of the form, fill in the description of the item(s) for which you are seeking permission and, near the bottom, your proposed credit line. Send two copies of the letter and form to each recipient.]
Dear [name],
I am [a contributor to] [the author of] [the editor of] the book tentatively entitled [title] (the “Work”), currently scheduled to be published by the University of Calgary Press in [year]. I am writing to ask for your permission to reproduce [an excerpt] [excerpts] [an illustration] [illustrations] in the Work.
This is a work of scholarship with a limited audience. To achieve broad dissemination of the Work to scholars, I hope to use electronic form in addition to print editions. With that in mind, I request a nonexclusive license as described in the following form. Please note that the statement asking permission to give rights, licenses, or permission to others is intended for our distributors, those who may wish to publish a translated version, and/or perform a play (for example). At no time would we give permission to third parties to use your material outside the context of the Work.
[I am enclosing (a) photocopy[ies] of the excerpt(s) or the illustration(s)].
The University of Calgary Press is a nonprofit, academic publishing house. Given the scholarly nature of the publication I would be most grateful if you would waive any fee related to my request.
Please complete one copy of the enclosed form, sign it, and return it to me at your earliest convenience, together with one copy of this letter. The second copies of the form and the letter are for your records. You may fax the completed form and letter to me at [fax number].
Thank you very much for your help in this matter. If you have any questions, please call me at [phone number] or email your query to [email address].
Sincerely,
[name]
Permission Form
Please complete this form and return one copy to me, together with the attached letter. A second copy is enclosed for your convenience.
Description of item(s):
The source information that I have for [this excerpt] [these excerpts] [this illustration] [these illustrations] is as follows:
[For a text, give the author, complete title, complete publication details for the journal or book in which the excerpt appeared, including page numbers. Cite the first and last few phrases of the passage and indicate the total number of words.]
[For a photograph, give the name of the photographer and a brief description of the subject of the photograph or (where applicable) the creator and title of the work shown in the photograph. For another type of illustration, such as a map or diagram, or for a table, give complete source information as for a text, along with a brief description and the name of the creator, if known.]
Type/Territory: Non-exclusive, Worldwide
Language(s): All languages
Revisions: The forthcoming editions and all revised editions of the Work
Formats (Please check both boxes if agreeable):
A. Print
Media: All print media now or hereafter known, including, without limitation, media for people with reading-disabilities, and works based on the book.
Purpose of Reproduction:
Print copies for sale and promotional purposes
Print and digital advertising and marketing materials promoting the Work
Rights, licenses, or permissions granted to others to sell, publish or perform the Work in complete, partial, condensed, adapted, or abridged versions
Print Run: Initial print run of approximately 750. Any subsequent print runs will be less.
B. Digital
Media: All electronic/digital media now or hereafter known, including, without limitation, media for people with reading-disabilities, and works based on the book.
Purpose of Reproduction:
Digital copies for sale and promotional purposes
Print and digital advertising and marketing materials promoting the Work
Posting in an open access format on the University of Calgary Press website. This means the Work will be licensed under Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 Unported (International) http://creativecommons.org/licenses/by-nc-nd/3.0/.
Rights, licenses, or permissions granted to others to sell, publish or perform the Work in complete, partial, condensed, adapted, or abridged versions
Please check one:
The following credit line is acceptable [Applicant: insert proposed credit line here]:
OR
I/we prefer the following credit line (for a work of art, please specify medium, dimension, date, and location):
Fee: Waived (or) $ ______
I/we hereby grant permission for the use of the excerpt(s)/illustration(s) as outlined here and in the accompanying letter.
I/we warrant that I/we have the legal authority to grant the rights specified.
Signature: Date:
Printed Name: ______