Dear Publisher/Copyright Holder:
I am writing to request permission to use the following material in my class at the University of Northern Iowa:
[Complete citation of work. Be as specific as possible, including chapter and page numbers]
University policy requires permission be granted by the copyright holder if the material is to be made available on reserve for more than one semester. Access to this material will be restricted to students, faculty, and staff of the University of Northern Iowa. The material will only be located by searching for a particular course or professor, and will not be listed by author or title.
Because time is of the essence, I would appreciate an early reply to this request. I have enclosed a self-addressed envelope for your convenience. Thank you for your assistance in this matter.
Faculty Member Name