Sample Copyright Permission Letter for a Thesis or Dissertation
Request to Use Copyright Material Owned by Other than the Thesis Writer

[Copyright owner’s details]

[Date]

[Your details]

Dear [Copyright owner’s name]

I am completing a [Masters thesis / PhD dissertation] at the University of Victoria, British Columbia, Canada, entitled “ [ title ].”  I would like your permission to reprint in my [thesis/dissertation] [excerpts / images] from the following:

[full citation]

The [excerpts/images] to be reproduced are:

[full description of the material]

The requested permission extends to any future revisions and editions of my [thesis / dissertation], including non-exclusive world rights in all languages, and to the prospective publication of my [thesis/dissertation] by the National Library of Canada [and Proquest].  [Theses / Dissertations] published at the University of Victoria are also made digitally available on the Internet for public access via the university’s Institutional Repository (UVic Space).  For more information on the UVic Space see: https://dspace.library.uvic.ca:8443/ .

These rights will in no way restrict republication of the material in any other form by you or by others authorized by you.  Your signing of this letter will also confirm that you own (or your company owns) the copyright to the above-described material.

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

Sincerely,

[your name]

PERMISSION GRANTED FOR THE USE REQUESTED ABOVE:

______________________________			______________________________
[Name of addressee] 				[Title]

______________________________
Date