[Date]
[Address]
Dear [Name],
I am writing to request your permission, as copyright holder, to reproduce [your work / work by an artist that you represent] in [black and white / color] entitled [name of the image].
This image will appear in an article by [author] currently entitled [working title] to be published in the on-line, scholarly journal Genders in [season, year]. This is a journal that is targeted to reach a specialized academic audience.
I am requesting non-exclusive world rights to include this image in my article, which will be published online. The expected size of the reproduction is [1/4 page, 4” x 6”, etc.]. [Please note that I have the images and am only writing to request permission to reproduce them.]
If you are the rights holder, may we have your permission to reprint the work described above? Please indicate how you would like the journal to acknowledge your work. If you are not the rights holder, but you know who does currently have the copyright rights, we would be most appreciative if you would provide us with their name, affiliation, or any other contact information.
Please sign on the line provided below and return an executed copy of this letter to me if you agree to confer the right requested in this letter. Please feel free to contact me with any questions or to discuss this request at [contact information].
Thank you for considering this request.
Yours sincerely,
[Author]
The above request is hereby approved on the conditions below, if any, and on the understanding that full credit will be given to the source.
Approved:_________________________________________________________________ Date:_____________________________