Tuesday, May 26, 2009

Bellingham Technical College

3028 Lindbergh Avenue

Bellingham, WA 98225

Phone 360.752.7000

Fax 360.676.2798

Name of copyright holder

PO BOX 0123

City, State ZIP

Dear Rights holder/permissions editor/personal name:

I am a faculty member at the Bellingham Technical College. Our Department/program here faculty members are in the process of creating a hybrid course. Our library owns the following video, Title of video, which I believe you hold the copyright to. This work has important educational value that our students could benefit from. I would like to request permission to make the following AV materials available to students in my online course(s) Name of course here.

Video/Audio Title: Title and format here

Copyright year: Copyright year here

Producer/distributor: Name(s) here

Publisher: Publisher here

The Course name & number, Title of course … describe the project.. I anticipate material will be used for x number of quarters per academic year and for x number of class(es). Each class will have approximately x number of students. The AV material(s) will be hosted on a secure website that is password protected. AV materials will be watched, outside of class online. The network that will host this online course is the Washington Online (WAOL) and is available at https://www.waol.org/index.aspx.

If you are not the copyright holder on the above mentioned materials, I would appreciate any contact information you can give me regarding the proper rights holder(s), including current address(es). Otherwise, your permission confirms that you hold the right to grant the permission requested here.

I would greatly appreciate your consent to my request. If you require additional information, please do not hesitate to contact me. I can be reached at:

First name Last name

3028 Lindbergh Ave

Bellingham, WA 98225

p. 360.752.8xxx

f. 360.752.8xxx

AName@btc.ctc.edu

A duplicate copy of this request is being sent for your records. If you agree to the terms described above, please sign the release form below and send me one copy with the self-addressed stamped return envelope I have provided.

Sincerely,

First name Last name, Faculty

Permission granted for the use of the material described above:

Agreed to:	Name & Title:

Company/Affiliation:	Date: