Request for Copyright Permission Form
When requesting permission directly from a copyright holder, simply e-mail or write to him/her, explaining how and why you want to use the work and requesting permission. The permission should be in writing: an e-mail will suffice. Verbal permissions should not be used. The permission must come from the copyright owner. It is also a good idea to keep a file record of who gave the permission, what was permitted, the date, and how to contact the person who gave the permission. This form will assist you in gathering all the information you need to obtain use of copyright material from an individual copyright holder.
By submitting a completed form to the Copyright Office we can keep the permission on file.
For an interactive pdf version of the form, click here.
*Please note not all browsers support interactive PDF formats, please download the document and open in Adobe to ensure functional format.
For word version of the form, click here.