Permission to Reprint for Coursework

PERMISSION TO REPRINT PUBLISHED MATERIAL FOR COURSEWORK

Dear {Copyright Holder},

I am an educator at {educational institution} teaching a class on {subject} from {course start date} to {course end date}. I am seeking your permission to reprint the following material:

{Title, Author. Edition. Publisher, Date.}

{Page numbers, description of material, lines of poetry, beginning and ending quotations, video, song lyrics, or full excerpt}.

The material will be presented in the following way: {method of presentation, including viewings, reprintings, digital/hard copies}. Only registered students will have access to the material, and they will only be able to access it via {method} until {termination date}.

Credit will be listed as {Credit} {at the end of the material, in a footnote on the same page, in the syllabus, on the website, etc.}

Please fill out the release form below and return it to me at {address}. Or, feel free to contact me at {contact information}. Thank you.

Sincerely,
{Name}

I, ________________________________, the copyright holder of __________________, hereby grant ______________________________ permission to use the aforementioned material solely in the capacity listed above. I understand that this permission is legally binding and non-revocable.

I grant my permission with the following conditions:

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(Grantor Signature)

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(Date)

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