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REQUEST TO
REPRINT COPYRIGHTED MATERIAL
BY
NONPROFIT ORGANIZATION
To:
______________________________________________ (Copyright Holder)
 __________________________________________________
(Address)
Re:Â
____________________________________________ (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).
____________________________________Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â __________________
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.
___________________________________Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â __________________
Signature of Copyright Owner                                         Date
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