The following may be used as a template when requesting publisher permission to reproduce copyrighted material for classroom and teaching purposes. If you are requesting permission to reproduce materials for Electronic Reserves, please review the information on the Reserves Department page.

Letters should be addressed to the Permissions Department of the Publisher or copyright holder. Addresses may be obtained from the Library Reference collection or via Books in Print in GALILEO.

REQUEST FOR PERMISSION: Classroom Use

Date:

TO:

I am writing to obtain permission to duplicate the following material(s) for classroom and teaching purposes at Armstrong Atlantic State University.

Journal or book title:

Journal issue or book edition:

Copyright or publication date:

ISBN for books, ISSN for magazines and journals:

Author's full name:

Article title or book chapter:

Pages:

Name and number of academic course:

Expected class size:

Semester / year course is taught:

Item may be assigned in future semesters: _____ Yes ______ No

Name of instructor:

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. Please specify here any additional source from whom permission must be obtained:

Thank you for your prompt consideration of this request. Please apprise me of your decision at your earliest convenience.

Sincerely,

Requester's Name:
Address:

Fax:
E-mail:

The above request is approved, subject to the conditions noted above.

Approved by:
Date: