Date:

To:          [Copyright Holder]

From:      Professor
               Department
               University of Wisconsin-Milwaukee

Re:          Permission to use copyrighted material

I would like your permission, as the holder of the copyright for the material listed below, to allow the material to be scanned by the UWM Libraries and made available via their electronic reserve sysytem to the students in my class.

Materials included in electronic reserve are only accessible to those with a UWM IP address, or through a proxy server which authenticates UWM students and faculty, or to distance education students who have been given a special password by their instructors.   Materials on electronic reserve may not be searched by title or subject, but only by faculty name and department or course number.  The reproduction will faithfully copy the work in its entirety and will include a copyright notice.

Citation of material to be used:

author(s):
title of article/chapter:
journal/book title:
date/volume/edition:
chapter(s)/pages to be scanned:

Thank you for your prompt reply to this request and for assisting in the educational process at the University of Wisconsin-Milwaukee.