UNIVERSITY OF ILLINOIS AT URBANA-CHAMPAIGN

Digital Content Creation Team

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Permission Request Template

This page provides a template letter to request permission to digitize materials that are under copyright, where the copyright holder is known. The template letter must be adapted to the specific project by customizing the text in red. The text in blue must be used as is without changes. It was approved by campus legal counsel on March 10, 2005. A copy of a signed copyright permission form MUST be retained permanently in the University Librarian's Office.

If you feel this template does not adequately address your needs, please contact the Digital Content Creation Team or the Head of the Digital Services Development Unit.

Front of letter. Letter must be sent on library letterhead.

DATE

Addressee
city
state, zip

Dear [Contact Person]:

I am writing to request, on behalf of the University Library at the University of Illinois at Urbana - Champaign, copyright permissions pertaining to the item(s) listed on the reverse of this page. Our aim is to digitize the work(s) in order to increase availability for educational and research purposes. The following Notice of Copyright will be included on the website where the work appears:

"The digital reproductions on this site, from materials held by the University Library at the University of Illinois at Urbana-Champaign, are provided to University of Illinois at Urbana-Champaign students, faculty and staff, and other researchers who visit this site, for research consultation and scholarly purposes only. Further distribution and/or any commercial use of the works from this site is strictly forbidden without the permission of [name of the copyright holder]."

[Insert sentence or paragraph describing project and rationale for digitizing here]

Full acknowledgement will be given to the rights holder for a given work when the digital reproduction is accessed. If you are not the copyright holder or do not have authority to grant this request, we would greatly appreciate any information you can provide concerning the current copyright holder.

Please review the reverse of this letter, sign it, and return it to me using the enclosed self-addressed stamped envelope. A copy of this letter is also enclosed for your files. If you have any questions or concerns, please contact me.

Thank you in advance for your assistance in allowing us to make these works more widely accessible and useful for scholarship.

Sincerely,


[UIUC Library Contact Person]
University of Illinois at Urbana-Champaign
[Address]
[Phone]
[Email]

Reverse of letter

The University of Illinois at Urbana-Champaign Library is seeking permission for use of the following copyrighted work(s):

[list library materials for which permission is sought here, using as much detail as possible].

 If you are not the rights holder, please check here and complete the following if possible. Otherwise, please review the rest of the form and sign at the bottom.

I believe the rights holder may be:
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

We request permission for the use of your copyrighted work(s) by the University of Illinois at Urbana-Champaign Library for the purposes described on the front side of this letter, to:

[you may include any or all of the following bulleted items in the letter, as they apply to the specific project for which permission is being sought. If you need different permission, please contact the head of DCCT or DSD.]

1. to make a digital reproduction of the work(s), and to retain the digital reproduction.
2. display digital reproductions of the work(s) via the Internet
3. display digital reproductions of the work(s) via the Internet, restricted to University of Illinois at Urbana-Champaign students, staff, and faculty members
4. distribute single copies of the digitized work to library users for purpose for educational and research purposes. (Reproduction fees may be charged according to the Library's fee schedule.)
5. index or encode the work(s) so that they can be retrieved by a search engine
6. use all or portions of the digital reproductions of the work(s) for website design related to the work(s)

"I confirm that I am the rights-holder for this work, or have authority to grant permission to use the work, and that I grant permission for the use of the work(s) by the University of Illinois at Urbana-Champaign according to the terms indicated in this letter, for educational and research purposes."

__________________________________________
Signature