Intellectual Property Permission Letter - Template Form

________

From:
________
________
Email: ________
Telephone: ________

To:
________
________

Re: Request for Permission to Use Copyrighted Work for Educational Purposes

Dear ________:

My name is ________, and I am writing to respectfully request your permission, as the owner of the copyright and any other intellectual property rights in the work identified below, to use such work for a specific educational purpose. I make this request in recognition of your exclusive rights under the United States Copyright Act, 17 U.S.C. § 101 et seq., and in particular the rights of reproduction, distribution, display, performance, and the preparation of derivative works set forth in 17 U.S.C. § 106.

1. Description of the Work. The work for which I seek permission (the “Work”) is described as follows:

________

To the extent applicable, the Work is further identified by the following title, author, publication, edition, and registration or identifying information:

________

2. Intended Use and Purpose. I intend to use the Work for the following educational purpose:

________

Lorem ipsum dolor sit amet consectetur adipiscing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliqua ut enim ad minim veniam quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat duis aute irure dolor in reprehenderit voluptate velit esse cillum dolore eu fugiat nulla.

3. Scope of Requested Permission. Specifically, I request permission to reproduce, display, and/or distribute the Work in the following manner, medium, and quantity:

________

The requested permission would be exercised in connection with the following institution or program: ________, located at ________.

4. Duration and Territory. I request that the permission extend for the following period and territory:

Term: ________
Territory: ________

Lorem ipsum dolor sit amet consectetur adipiscing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliqua ut enim ad minim veniam quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat duis aute irure dolor in reprehenderit voluptate velit esse cillum dolore eu fugiat nulla pariatur lorem ipsum dolor sit amet consectetur adipiscing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliqua ut enim ad minim veniam quis nostrud exercitation ullamco laboris.

6. License Terms and Fees. Please advise me whether you require a signed license agreement, the payment of any license fee or royalty, or any additional terms or conditions as a condition of granting permission. If so, kindly include those details in your written response and I will gladly review and comply with them. I propose the following compensation, if any, subject to your agreement: ________.

7. Written Response Requested. Please let me know, by written response, whether you grant permission to use the Work as described. No use of the Work will be made in reliance on this request unless and until I receive your written permission. I would appreciate a response on or before ________.

8. No Waiver. Nothing in this letter shall be construed as a waiver, limitation, or admission by either party regarding any rights under applicable law, including any rights or defenses arising under 17 U.S.C. § 107.

I appreciate the time you have taken to consider this request and look forward to your response. Should you have any questions, please contact me using the information provided above.

Sincerely,

_______________________________
________
________

PERMISSION GRANTED — To be completed by the Owner (optional):

I, ________, as owner of, or authorized representative for the owner of, the rights in the Work, hereby grant permission for the use of the Work upon the terms set forth above, subject to the following additional conditions (if any): ________.

Signature: _______________________________
Name: ________
Title: ________
Date: ________