[This is a generic sample letter; all parts may not apply precisely to the item for which you are requesting permission. Please modify as necessary and submit on your organization's official letterhead. You will receive a response within 6 weeks; information about applicable costs (if any) will be included.]
[Date]
Copyright Officer
The National Center for Education in Maternal and Child Health, Georgetown University
2000 15th Street, North, Suite 701
Arlington, VA 22201-2617MCH Group at Georgetown University
2115 Wisconsin Avenue NW, Suite 601
Washington, DC 20057
Mailing Address: Box 571272
Washington, DC 20057-1272
Attention Copyright Officer:
I am requesting permission to [reprint/reproduce/adapt/translate] [table/figure(s) number and title, or chapter numberitem you wish to use] from [page number(s) (if applicable)] of [title (if applicable)]and by [authors of journal article, name of journal, and volume/issue number(s), or book title and author/editor]. I would like to include it in [name of book/reportpublication], which will be published [approximate publication date] by [your organization’s name], [description of your organization.]*
[Your organization’s name] will include a credit line to the National Center for Education in Maternal and Child Health (NCEMCH)(specified belowby NCEMCH).,with the [table/figureitem you have requested permission to use]. [Your organization’s name] will state in [publication title] that readers are to receive permission for duplication of any cited materials from NCEMCH (the publisher). When using NCEMCH materials that have been adapted/cited from other sources, you must cite NCEMCH and the original source and advise readers that they must do the same.
The approximate print run will be [projected number of copies to be printed], and the publication will be [distributed free of charge/sold /for an approximate amountcost of ______] by [distribution company/organization] to [general audience] [for [intended purpose] [by distribution company/organization]. I am enclosing copies of the original [table/figureitem] and of the version in our manuscript. If you could respond by [date], that would help us stay on schedule. If you have any questions, please contact me at [contact number.].
Thank you.
Sincerely,
[Your Name]
Please sign or stamp here to indicate approval/permission to use material(s) mentioned above:
______.
Please include the following credited line:
[Credit line to be supplied by NCEMCH.]
* Be sure to mention if your organization is a nonprofit,status since publishers often waive or reduce permission fees for materials used for nonprofit purposes. Also be sure to mention any plans to put the publication on the Web or on CD-ROM, because this kind of use (i.e., electronic or multimedia use) requires an additional or separate granting of permission.