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Sample Copyright Permission Letter
[letterhead stationery or return address]


[Name and address of addressee]

Dear ______________________:

I am completing a doctoral dissertation at The University of Memphis entitled "_______________________." I would like your permission to reprint in my dissertation excerpts from the following:

[Insert full citation and description of the original work.]

The excerpts to be reproduced are: [insert detailed explanation or attach copy].

The requested permission covers future revisions and editions of my dissertation and to the prospective publication of my dissertation by UMI. These rights will in no way limit republication of the materials in any other form by you or others authorized by you. Your signing will verify that you own [or your company owns] the copyright to the above materials.

If this meets with your approval, please sign this letter below and return it to me in the enclosed return envelope. Thank you very much for your attention to this matter.


[Your name and signature]



[Type name of addressee below signature line]

Date: _________________________

Instructions for permission letters:

  1. Be sure to include your return address, telephone and fax numbers, and date at the top of your letter.
  2. Verify the exact name and address of the addressee. Call the person to verify copyright ownership.
  3. Clearly state the name of your university and your dissertation's title.
  4. Describe the proposed use of the copyrighted material. If necessary, attach a copy of the quotations, diagrams, pictures, and other materials. If the proposed use is extensive, describe it in broad terms. Eliminate any ambiguities and be sure that your request for permission covers the full scope of your needs.
  5. The signature line at the bottom of the sample letter is appropriate when an individual grants the permission. However, when a company, such as a publishing house, is granting permission, use the below signature format:


    [Type name of company]

    By: _______________________________

    Title: _______________________________

    Date: _______________________________

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Last Updated: 1/24/13