Sample Letter Requesting Permission to Use a Psychological Test Form

SAMPLE LETTER REQUESTING PERMISSION TO USE A PSYCHOLOGICAL TEST

DOMINICAN UNIVERSITY of CALIFORNIA

September 1, 2003

Princeton University Press

41 Williams Street

Princeton, NJ 08540

RE: Couch Potato Inventory 

Dear Madame or Sir:

I am writing to request written permission to use the Couch Potato Inventory (Remote, 1993) in my undergraduate research project relating stress levels to the amount of time adolescents spend watching television. This project is part of an undergraduate senior thesis research requirement in psychology at Dominican University of California.

I would also appreciate receiving copies of the test/questionnaire, the standard instructions for administering the test, and scoring procedures.

My research is being supervised by my advisor, Dr. Robert Knodoz, Psychology Department, Dominican University of California, San Rafael, CA, 94901, (415-889-9000). 

If this request meets with your approval, please sign, date, and return this letter to me in the enclosed self-addressed, stamped envelope. I am also enclosing an additional copy of this letter for your records. 

If you have any questions, please do not hesitate to contact me or, if you prefer, Dr. Knodoz.

Thank you for your help.

Sincerely,

Samantha J. Student

2001 Graduation Gardens

San Rafael, CA 94903

510-667-8888

I agree to the above request.