GNC(EXHIBIT) - RELATIONS WITH EDUCATIONAL ENTITIES: COLLEGES AND UNIVERSITIES

The following forms will be used by the District in approving outside groups to conduct re-search in District schools:

EXHIBIT A

APPLICATION TO CONDUCT RESEARCH

Name:

Address:

Telephone Number:

Affiliation:

Abstract (purpose, rationale, sample design and procedures, data collection procedures, analysis procedures, use of results):

(use reverse side of sheet if necessary)

Instrumentation (attach):

If you are conducting research as part of a graduate program, please indicate:

Degree on which working (circle one):MastersDoctorate

Approval of Professor or Committee (circle one):YesNo

Name, address, and phone of supervising professor or advisor:

Signature of Applicant

EXHIBIT B

Dear Dr.

Attached are the Behavior Rating Scales completed on _______________ as you requested. We are aware that all such scales have a very low reliability and that the information should only be used to reinforce the results of other, more accurate measures. It should also be remembered that this view of the student is situation specific and does not rate him or her to age-mates in general.

Please feel free to contact me directly if you need further assistance in treating this child.

Yours very truly,

Psychologist/Physician

EXHIBIT C

RELEASE OF INFORMATION

I, ___________________________, as parent or guardian of _______________________ do hereby authorize the school counselor of ____________________________ school to assist my child's teachers to complete the behavior rating scales that have been requested by my child's physician/psychologist.

I further authorize the release of this information, as well as other information the counselor may obtain that will assist in the diagnosis and/or treatment of my child, to the following health service professional:

PROFESSIONAL'S NAME:

ADDRESS:

PHONE:

Signature of Parent or Guardian:

Student ID DOB:

Area of concern

Spring ISD

GNC(EXHIBIT)-X

LDU-14-03

DATE ISSUED: 4/7/2003