Permissions Template

[Letterhead or return address]
[Name and address of addressee] 

Dear _______: 

I am writing a scholarly article/book, entitled "             " to be published by [publisher, name of journal/journal publisher] and would like your permission to use in the article/book the following work/s: 

[Insert full citation and description of the original work/s: author, title, edition number, volume number, issue number, page numbers, number of figure/table/illustration, section/part you wish to use; place of publication, publisher, date of publication of original work/s.] 

[If appropriate, add a more detailed description of your use or attach a copy.]

The requested permission extends to any future revisions and editions of my article/book, and also to the prospective public distribution of my article/book in the Rutgers University open-access repository, subject to the terms of my publication agreement and to my decision to make it openly accessible. Full attribution to the original source will be given.

Your signing this letter will confirm that you [or corporate entity] own the copyright to the above-described material. If you do not hold the copyright in this material, I would appreciate any information you could provide about others to whom my request should be directed, along with contact information if possible.

If this use meets your approval, please sign this letter where indicated below and return it to me in the enclosed return envelope. Thank you very much. 


[Your name and signature] 


I have the authority to grant the permission requested above and hereby grant permission for use of the above-referenced material in the manner described.

Signature of copyright holder

Name of copyright holder


Address of copyright holder