Brown University Copyright and Fair Use

Brown University
 Sample Letter Requesting Permission

The request should be sent, together with a self-addressed return envelope, to the permissions department of the publisher in question.


Permissions Department

Dear Permissions Editor,

I am writing to ask your permission to (circle all that apply)

  • reprint
  • photocopy
  • quote from
  • incorporate into:
    • multimedia courseware
    • online course materials
    • a dissertation/thesis
    • a print publication
the following material:
Book Title:
Journal Title: Volume: Issue:
Page #(s) Figure/Image #(s) Table #(s)

The material will be distributed as follows:



Expected distribution/publication date:

Expected length of work (number of images, etc.)

Target market:

If you do not solely control copyright in the requested materials, I would appreciate any information you can provide about others to whom I should write, including most recent addresses if possible.

[Optional:]Enclosed please find a draft License Agreement for your convenience in responding to this request.]


Please initial any statement that applies:

  • I hereby represent that I have the authority to grant the permission requested herein.
  • I am the sole owner/author of the work.
Author Signature Company Signature
_________________________ _________________________
Author's Name Authorized Signatory
_________________________ _________________________
_________________________ Title
_________________________ _________________________
Address Company