Mrs.

Davis 4th Grade Class Copyright Permission Request Form

[Insert Date] [Insert creators name and address] Dear [Ms. or Mr. - Insert creators last name] : I am researching and gathering information about [insert detailed subject here] for a school report/project/presentation. I have found some of your remarkable work that would enhance the clarity of my focus. I am writing to ask for your permission to include the following material in my project. [Insert detailed citation with source information here] This school project will be presented in the form of a [insert details here i.e., written report / oral presentation / poster / video, etc.] and will only be accessible to students, teachers, and parents of our school. Your copyrighted material will in no way be used for financial gain. I would greatly appreciate your consent to my request. If you require any additional information, please do not hesitate to contact me. I can be reached at the following address: [Insert your first and last name] c/o Mrs. Davis 4th Grade Class Sunrise Elementary School 1520 E. 11265 South Sandy, Utah 84092 Please indicate below whether you agree with the terms as described above and sign the release form below. I have included a stamped, self-addressed return envelope for your convenience. Thank you very much for your consideration and time. Sincerely, [Type your first and last name here] Permission IS granted for the use of the material as described above: Agreed to: Name/Title: Company: Date:

Permission IS NOT granted for the use of the material as described above: Name/Title: