R EQUEST FOR P ERMISSION F ORM /D UPLICATION OF C OPYRIGHTED M ATERIAL DATE
Permission Department Harvey Book Company 3 West Road Baltimore, Maryland 21214 Dear Permission Department Representative: I would like permission to make duplicate copies of the following for my classes: Title: Helping the School Librarian, Second Edition Copyright: Harvey Book Company, 1965, 1971 Author: Sara Howes and Don Johnson Materials to be Duplicated: Pages 23, 24, and 57 (photocopies enclosed) Number of Copies: 25 Distribution:
Continuing Education Classroom; the material will be distributed gratis to students.
Course:
No. and Title: (Course No. 33031-Basic English)
Permission Request: Term to be Used (Fall, 2016) Material on the pages listed above will be used as supplementary materials for my <CLASS NAME>. This would not be used for profit-making purposes, and would serve the academic needs of my students. A duplicate copy of the request and a self-addressed return envelope are enclosed for your convenience. Thank you for your cooperation. Sincerely,
<NAME> <TITLE>
Appendix G
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