[ACC stationery with return address]
FAX: [Include your FAX number for a speedier response]
[Date]
Permissions Department
[Company Name and Address]
Dear _____________________________;
[If you called first, begin your letter: This letter will confirm our recent telephone conversation.] I am [identify
your position] at Adirondack Community College. I would like your permission to duplicate the following
recorded media for my course [give the course number and title]:
[Insert full citation; then identify specific segments if you
don’t intend to use the entire recording.]
[Explain why you need to duplicate it: e.g., Is it an LP unavailable on cassette? Do you need a brief segment for
a Web page? ] I will use this material only for the intended course, and only students enrolled in this course will
have access to it.
Please indicate your approval of this permission by signing the letter where indicated below and returning it to me
as soon as possible, preferably at the above FAX number. Your signing of this letter will also confirm that you
own [or your company owns] the copyright to the above described material.
Thank you very much.
Sincerely yours,
[Your signature and name]
Permission granted for the use requested above:
_____________________________________________
Signature
[Type name of addressee here]
_________________________________
Date ____________________________
Based on model in Fair Use of Copyrighted Works: A Crucial Element in Educating America, CETUS
Discussion Series, 1995; page 30.
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