Mount Vernon Nazarene University

Staff Handbook

Sample Permission Letter

Date

Materials Permission Department

Anonymous Book Publishers

100 Nowhere St.

Nowhere, NY 13256

To Whom It May Concern:

I am requesting permission to copy the following for continued use in my classroom for [course number and name]:

Title:

Author:

Specific duplication needs: [i.e. chapter title, chart, etc.]

Distribution: To the students of my [course number and name]

Type of duplication: [i.e. photocopying, digital, etc.]

Purpose of use: [i.e. To supplement the course materials]

Sincerely,

[Signature]

[Name]_____________________________________________________________________________

[Address]___________________________________________________________________________

Please initial the appropriate statement.

I herby represent that I have the authority to grant permission requested herein for the use of [title] and:

___________Do grant the permission.

___________Do not grant the permission.

 

Signature

 

Name of authorized signatory

 

Title

 

Company

 

Date

 

Title

 

Company