ࡱ>  Lbjbj __, VVVVV$zzzP\&$z#JJ"lll"""""""$$'j"V""VVll0"dVlVl""g  /"R {""0# ,(t( \(V!l""p#( X :  TEACHERS COLLEGE, COLUMBIA UNIVERSITY Approval to Conduct Research at an External Site {To be reviewed and signed by of External/Off-Campus Research Site Administrator} {Name of External/Off-Campus Research Site} {Name of External/Off-Campus Research Site Contact Information} {TC IRB Protocol Number} ___________________ ______, __________ Month Day Year Dear 911Թ College Institutional Review Board (TC IRB), Based on my review of the proposed research by {primary investigators name, and faculty supervisor if applicable}, I give permission for the researcher to conduct the study entitled {study title} within {name of research location}. As part of this study, I authorize the researcher(s) to {general descriptions of researchers activities at partner site, e.g., specific recruitment, data collection, and results dissemination activities}. Individuals participation will be voluntary and at their own discretion. I understand that our organizations responsibilities include: {insert descriptions of the following, as applicable: personnel, rooms, resources, and supervision that the partner will provide}. We reserve the right to withdraw from the study at any time if our circumstances change. I understand that the research will include {insert brief description of the interaction with human participants at the partner site, e.g., typical practice, pre-tests, and post-tests.}. This authorization covers the time period of {_____ to ______}. I confirm that I am authorized to approve research in this setting. I understand that the data collected will remain entirely confidential and may not be provided to anyone outside of the research team without permission from TC IRB. As the study site, I agree to comply with all local, state, federal guidelines and any guides specific to our operation for maintaining a clean and safe research environment at all time, and especially during a state of emergency like the COVID-19 pandemic. Sincerely, {External/Off-Campus Research Site Administrator Authorization Official signature} {Authorization Official Title, Cooperating School Name} {Contact Informationemail & phone number} TEACHERS COLLEGE, COLUMBIA UNIVERSITY Time Period of {_____ to ______} COVID-19 EXTERNAL/OFF-CAMPUS RESEARCH SITE NOTIFICATION FOR PLACEMENTS {This document should accompany the external site permission form} {Name of External/Off-Campus Research Site} {Name of External/Off-Campus Research Site Contact Information} {TC IRB Protocol Number} ___________________ ______, __________ Month Day Year Dear _____________________________________________________________________, {Name of External/Off-Campus Research Site Administrator} At 911Թ College, the health and safety of our staff, student, and faculty researchers (Researchers) is of paramount concern during the current pandemic, due to COVID-19. To that end, since some of our Researchers may be performing in-person research at your site for the time period of {_____ to ______}, 911Թ College expects your site to comply with all local, state, federal guidelines and any guides specific to your operation for maintaining a clean and safe research environment at all time, and especially during a state of emergency like the COVID-19 pandemic. If your research site is located outside of the USA, we expect your site will comply with your jurisdictions safety guidelines for a pandemic (COVID-19) or emergency, and the safety guidelines required by 911Թ College. As a host site for research your site will provide our Researchers with adequate personal protective equipment (PPE) for all in-person activities on your site, commensurate with the level of PPE provided to staff members engaged in similar activities. If providing PPE to researchers is not possible, your site will provide adequate guidance on how to acquire proper face coverings, PPE, or other specialized equipment to engage on your site. Furthermore, 911Թ College reserves the right to remove our Researchers from your research site at any time if we learn that your site is out of compliance with any emergency response or COVID-19 pandemic governmental guidelines. Additionally, Researchers reserve the right to leave your research site at any time if they believe that being present at the site would pose a health risk to themselves or their family members.       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