ࡱ> ;=:a {!bjbjjj 4"?b?bE ff$.^ggg,......$pR9(gg((RXXX(,X(,XXXͱ>^X0XXXgZ@X45gggRR*.ggg((((gggggggggfB : OCCIDENTAL COLLEGE CONSENT FORM TO CONDUCT RESEARCH ON SITE Faculty Supervisor/Principal Investigator:  FORMTEXT          Student Investigator(s)/Research Assistant(s):  FORMTEXT       Title of research project:  FORMTEXT       I acknowledge that on  FORMTEXT      , I was informed by  FORMTEXT       of Occidental College about this research project, the way it will be conducted and the conditions of participation in it . I have received copies of the appropriate documents checked below which provide the essential descriptions of the proposed project: ___ Informed Consent Form for Minor Child ___ Informed Consent Form for Adult Subjects ___ Parental Information Letter ___ Data Archival Consent Form ___ Informed Consent Form for Film Projects ___ Aforementioned documents in the appropriate and Documentaries/Subject Release Form language (if other than English) This institution is fully aware of the nature and extent of the subjects participation in this project and agree with full knowledge of all details to allow the subjects to participate. Subjects may withdraw their participation on this project at any time without prejudice or penalty of any kind. In the case of minors, parents/guardians will be informed that they may withdraw their childs participation on this project at any time without prejudice or penalty of any kind. On behalf of the institution, I give my consent for the research investigator(s) to utilize this site to recruit and interview its members/students. Permission to conduct research is granted beginning (date) ___________________ and ending (date) ___________________. Name (print): ________________________________________ Date: ____________________ Signature: ____________________________________________________________________ Title: ________________________________________________________________________ $&x~  & θݝ݆~zdݝ`UzhVRh5B*phhVR+jth)hYt#CJOJQJUaJhYt#hHsh [e-jhYt#OJPJQJU^JmHnHo(u5jhYt#CJOJPJQJU^JaJmHnHo(u+jh)hYt#CJOJQJUaJh)hYt#CJOJQJaJ%jh)hYt#CJOJQJUaJh h1hh5&x(  e f   a Z['gd{Oa`gd98gd5$a$gd5     . J L N P d f h r t e f ַַֻֻ֠֠pֻlhd`UhBthBtCJaJhBthxhzhO@+jh)hYt#CJOJQJUaJhYt#+j\h)hYt#CJOJQJUaJh)hYt#CJOJQJaJhlhph55jhYt#CJOJPJQJU^JaJmHnHo(u%jh)hYt#CJOJQJUaJ+jh)hYt#CJOJQJUaJ  / ` i p   #BDЪtltd`\h8-hHshfB*phhrHB*phhHshfB*phhQh,X9hPhCN<h{Oah{OaCJaJh{OaCJaJh5hBthBthBtCJaJh-B*CJaJphhHsh-B*CJaJphhCJaJh98CJaJhkCJaJh{CJaJhO@CJaJhBtCJaJ$DEFV&(wx [!z!{!ſh5h*xh 8Uh[8hm0<hm0<CJaJhm0<h,X9hPhPCJaJhP hHshCN< hCN<hCN< hCN<hP'(xyS T {!gd5 Name of the institution: _________________________________________________________ Address: _____________________________________________________________________ Phone number: ______________________ Email: ___________________________________ The institutions representative should sign two copies of this form. Keep one copy and return the other copy to the investigator. 21h:p / =!"#$% tDText1tDText1tDText1tDText1tDText1s2&6FVfv2(&6FVfv&6FVfv&6FVfv&6FVfv&6FVfv&6FVfv8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@_HmH nH sH tH @`@ NormalCJ_HaJmH sH tH DA D Default Paragraph FontRiR  Table Normal4 l4a (k (No List HH O@ Balloon TextCJOJQJ^JaJPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭Vc:E3v@P~Ds |w< E " D{! '{! kw} '39NZ`E FFFFF8@0(  B S  ?(}!)}!*}!+}!,}!-}! eepG  owwG =*urn:schemas-microsoft-com:office:smarttags PlaceType=*urn:schemas-microsoft-com:office:smarttags PlaceName9*urn:schemas-microsoft-com:office:smarttagsplace G #'5Cqt6Fz G 3333333%%''::<<MMaaDDG DDG *)l[8i x-Yt#8-D.2 8,X9m0<CN<O@IHrHQ\2^{Oa [eHs*x-VRf -kBtPD7b{p981&5zE G @4E  @@@UnknownG.[x Times New Roman5Symbol3. .[x Arial7. [ @VerdanaK=   jMS Gothic-3 0000U  MS MinchoYu Gothic UI5. .[`)TahomaA$BCambria Math"h'Gbba24A A 3QHP ?52!xx x OCCIDENTAL COLLEGEmolik Windows User Oh+'0   @ L Xdlt|OCCIDENTAL COLLEGEmolik Normal.dotmWindows User4Microsoft Office Word@Ik@a@Lb ՜.+,0 hp  鶹Ƶ ITSA  OCCIDENTAL COLLEGE Title  !"#$%&'()+,-./013456789<Root Entry F@跜>Data 1TableWordDocument4"SummaryInformation(*DocumentSummaryInformation82CompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q