Request for Permission to Do Research in MCCSC Schools Office of ...

Request for Permission to Do Research in MCCSC Schools
Office of Early Field Experiences
W. W. Wright Education Building 1020
201 North Rose Avenue
Bloomington, IN 47405-1006
(812)856-8745 FAX: (812)856-8518
Researcher Name:
Date:
Address:
Phone:
Email:
Level: FR SO JR SR MA/MS PhD/EdD Faculty Gender: F M
Researcher’s Location: IUB IU Regional Other IN University Out-of-state University
Instructor/Adviser Name:
Office:
Phone:
Course # or Thesis:
Research Title:
Indicate Preferred Schools (and teachers, if applicable):
Indicate Preferred Grade Level(s):
Total Number of Students Needed for Sample:
Time Requirements:
Preferred Days:
Duration:
Frequency:
Starting Date:

Contract Agreement
The Office of Early Field Experiences has attached a separate set of the following materials for each
school involved and the MCCSC Central Administration Office:
• An abstract of the research proposal according to school specifications.
• Any related research instruments and/or necessary permission letters.
I, the Researcher, understand that a copy of the final research product must be made available to the
cooperating school corporation.
Researcher's Signature:
Date:
As IU instructor or faculty advisor to this student, I endorse the proposed research.
Signature:
Date:
IU Early Field Experiences Director's Signature:
Date:

Contract Acceptance/Rejection for
at
Contract Accepted
If accepted, school personnel should state any requirements expected of the IU Researcher and attach
any necessary forms or useful information.
Please sign, keep a copy, and forward the original immediately to the next appropriate person.
Central Administrator's Signature:
Date:
Principal's Signature:
Date:
Teacher's Signature:
Date:
Contract Rejected
If rejected, please offer some remarks, sign, and return immediately to the IU Office of Early Field
Experiences. Remarks:
Signature:
Date: