Name:   Date: Address:  Phone:   Email: Level: Fr So Jr Sr MA/MS PhD/EdD Fac    Sex: M F Course # or Thesis: Researcher's Location: IUB IU Regional Other Ind. Out-of-State University Instructor or Adviser: Office:    Phone: Research Title: Indicate Preferred Schools:     Indicate Preferred Teachers (if any): Indicate Preferred Grade Level(s): Total Number of Students Needed for Sample: Indicate Time Requests: Frequency Preferred Days:   Duration: 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: _______________________ IUOEFE Director's Signature: __________________  Date: _____________________         Contract Acceptance 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 Rejection If rejected, please offer some remarks, sign, and return immediately to the IU Office of Early Field Experiences. Remarks: _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ Signature: ______________________        Date: ___________________