Doing What’s Best for Kids

General Administration AP 190 - Form 190-2: Sample “Specific” Copyright Release Permission Form

After the initial telephone approval is given, a form letter such as the following may be used to request permission to photocopy class sets of articles from magazines such as Time, Maclean's, Saturday Evening Post.
(name and address of publisher from whom permission is sought)

Dear Sir/Madam:

Re: Request for Permission to Reproduce Material
As discussed, I am confirming your permission to photocopy a class set (35 copies) of the article, “Facing World Hunger” by Norman Basan, Canada and The World, September 10, 1991.
Enclosed are two copies of the Copyright Permission Form providing particulars regarding the materials to be reproduced. Please return one signed copy of the form and keep one for your reference.
If permission is granted, I undertake to ensure that any reproduction of the work is carried out in accordance with the particulars provided on the attached form, and that a notice of copyright is included with each copy.
If, in fact, you do not have the authority to grant permission to reprint the work in question, would you please forward this request to the appropriate person.

Thank you for your assistance.