Specifications

USE LETTERHEAD FROM YOUR COMMUNITY COLLEGE CAMPUS

(Insert Date)

(Insert Name/Address of the Copyright Owner Attn. Permissions Department)

Dear (Insert Name of the Contact Staff in the Company’s Permissions Department):

The purpose of this letter is to request authorization to (1) modify instructional audiovisual material to include captioning

and/or descriptive narration for students attending public postsecondary education at the (insert name of community

college) in (insert city), California; and (2) provide the captioned audiovisual material to other public California

Community Colleges, upon request, through interlibrary loan agreements.

Please complete the statement that appears on the bottom portion of this correspondence, and return it to:

(Insert Name, Title, Address, and Contact Information of College Staff Seeking Permissions)

This request is time-sensitive and requires an immediate response. Please reply on or before (insert date).

Title of Publication and Publishing Details:__________________________________________________.

Address/and Contact Information for Copyright/Trademark Owner:

______________________________________________________

The (insert name of community college) requests authorization to modify the audiovisual material to include

__captioning __descriptive narration for the purpose of ensuring access for students with disabilities within the

instructional setting for education purposes.

The (insert name of community college) presently owns ___ copies of the material. The material is used in conjunction

with classroom instruction for educational purposes. In addition, the material may be loaned to other public California

Community Colleges, upon request, through interlibrary loan agreements.

The audiovisual material will be used until such time the material is removed from (insert name of community college)

collection (unless the Copyright/Trademark Owner specifies an expiration date).

Your signature on this document confirms that permission has been authorized. This authorization will be clearly placed on

the audiovisual material, along with the date that permission was authorized.