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IMPORTANT: If you are seeking permission to use a work in a course pack: 1.) be sure to specify this intended use to the copyright owner/rightsholder in your letter, and inform them that the course pack will be sold via the Wheaton College Campus Store; and 2.) request that they give you a timeframe of how long this permission is granted (e.g. in perpetuity, x number of years, specific dates).

[If sending via postal mail, include a self-addressed, stamped envelope.]



[copyright owner’s or agent’s name and address]

Dear [copyright owner or agent]:

I am writing to ask your permission to use [give full citation of the work] for the purpose of [describe the intended use in sufficient detail].  

Please complete and return this form to me at your earliest convenience. Thank you very much for your consideration.

Sincerely yours,

[your name, position, and contact information]


I do _____ do not _____ grant permission for my work to be used for the purpose stated above.

Name __________________________________

Signature __________________________________

Date _________________________