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Back to Forms for 'Copyrights'.






To: ______________________________________________ (Copyright Holder)

 __________________________________________________ (Address)


Re:  ____________________________________________ (Material to be Reprinted)



We, ____________________________ (Name of Organization), are preparing materials for the purpose of teaching _________________________ (Subject of Teaching).  The previously mentioned materials will be used for/in ____________________________, and will be produced in _______ (Number) volumes.  In all, we would like to distribute approximately __________ copies.  The final product will be distributed without profit.  Following the above stated guidelines, we request your permission to reprint the following material: ___________________________________________________.


In addition, we will include a credit line in the reproduction which states the following: This material was reprinted from ____________________________ (Name of Original Publication), with permission from _______________________ (Copyright Owner).  Copyright Ó _____ (Year).



____________________________________                        __________________

Signature of Copyright Owner                                                       Date


With the signing of this document, permission is hereby granted to ______________________ (Name of Nonprofit Organization) to reprint the previously mentioned copyrighted material.




___________________________________                              __________________

Signature of  Copyright Owner                                          Date



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