<Attn: Permissions Department>
Dear Permissions Manager:
I am writing to request permission to reprint the following material from your publication:
Excerpt (pp. xx-xx) from <TITLE> by <Author> (<Copyright date>)
This material is to appear in <the tentative title of your publication> by <your name>, which will be published by the ESL/ELT Division of the University of Michigan Press, a non-profit organization, and used for educational purposes only. The book will be published in a paperback edition. The anticipated printing is approximately <print run> copies. It is due to be published in the <season> of <year of publication>. It will be priced at under $<price>.
[To determine what to fill in these blanks, contact firstname.lastname@example.org].
I am requesting world rights to use this material in the above work, all future editions, and in any ancillary materials. May I have your permission to reprint the material described above? Of course, it is understood that proper acknowledgment will be given, i.e., author, title, publisher, date, and copyright owner.
Thank you for your prompt attention.
The above request is approved on the condition specified and on the understanding that full credit will be given to the source.
Fee (if any):