1.(title of work) by (author, editor, photographer, etc.) which was
copyrighted (published) in _____ . (If we are talking about a photograph
where the name of the photographer is not apparent, describe exactly
where it appears. If we have an extra copy of the photo and cannot
describe it any other way, send the extra copy. There must be no
uncertainty about what we have been given permission to duplicate.)
2.The exact material to be used from the work is (list exact
page/paragraph numbers, text, etc. -- the copyright owner must know
exactly what we plan to use). The material will be copied/reprinted in
the following format: (e.g., photocopies, typeset, digitized, etc.)
3.We want to make (number) copies of the work.
4.The copies will be used (describe how they will be used, i.e., in a
course on marketing to be taught to students in __________ of
________________ at BBC&S, or in a brochure describing a course or
program).
5.The copied material will not (will) be sold. (If it will be sold,
some indication of the price and how the proceeds will be used would be
appropriate and helpful to the party deciding whether to grant
permission.)
Thank you for considering this request. We would be grateful if you
would respond by completing the attached form and mailing it to my
attention at: _____________________. If you need further information,
please contact at (570) 586-_____.