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September 19, 2002
Name of Principal, Director, PersoninCharge
Anyone’s Elementary School
1000 School Street
San Francisco, CA 94000
Dear Human Subjects Committee:
It is my understanding that Student Researcher Name will be conducting a research
study at Anyone’s Elementary School on “THE TITLE OF RESEARCH”.
Ms./Mr. Student has informed me of the design of the study as well as the targeted
population.
I support this effort and will provide any assistance necessary for the successful
implementation of this study. If you have any questions, please do not hesitate to
call. I can be reached at (000) 0000000.
Sincerely,
Name of Principal/Director/Personincharge
Title, name of school/agency/center/etc.
Date
Mr. X
Head of School or Center
Address
RE: Permission to Conduct Research Study
Dear Mr. X:
I am writing to request permission to conduct a research study at your institution or
(e.g., after school center). I am currently enrolled in the (specify program) at Notre
Dame de Namur University in Belmont, CA, and am in the process of writing my
(i.e., Master’s Thesis). The study is entitled (specify).
I hope that the school administration will allow me to recruit (i.e., specify x
number of individuals, boys, girls; indicate age of children) from the school to
anonymously complete a 4page questionnaire (copy enclosed). Due to the nature
of the study, I hope to recruit (the mother, father, or guardian) of these students to
anonymously complete their own 2page questionnaire (copy enclosed). Interested
students, who volunteer to participate, will be given a consent form to be signed by
their parent or guardian (copy enclosed) and returned to the primary researcher at
the beginning of the survey process. Parents who volunteer to participate will also
be given consent forms to be signed and returned to the primary researcher (copy
enclosed).
If approval is granted, student participants will complete the survey in a classroom
or other quiet setting on the school site. (Indicate when and where i.e., recess,
during school time, lunch, after school and ask permission for use of this time as
well). The survey process should take no longer than (specify time commitment).
Parent participants would complete the survey at home. The survey results will be
pooled for the thesis project and individual results of this study will remain
absolutely confidential and anonymous. Should this study be published, only
pooled results will be documented. No costs will be incurred by either your
school/center or the individual participants.
Your approval to conduct this study will be greatly appreciated. I will follow up
with a telephone call next week and would be happy to answer any questions or
concerns that you may have at that time. You may contact me at my email
address:_________________________________.
If you agree, kindly sign below and return the signed form in the enclosed self
addressed envelope. Alternatively, kindly submit a signed letter of permission on
your institution’s letterhead acknowledging your consent and permission for me to
conduct this survey/study at your institution.
Sincerely,
Researcher name and affiliation
Enclosures
cc: Dr. Z, Research Advisor, NDNU
Approved by:
_____________________ ____________________ _________
Print your name and title here Signature Date