Sample Authorization Letter Template printable pdf download

SAMPLE Authorization Letter Template

[Organization LETTERHEAD]

October 26, 2012

Institutional Review Board

c/o: Research & Sponsored Programs Office

CSU Channel Islands

One University Drive – Madera Hall 1300

Camarillo, CA 93012

Dear IRB Members,

After reviewing the proposed study, “[project title]”, presented by [name of

researcher], [title and department affiliation] at California State University Channel

Islands, I am granting permission for the study to be conducted at [school site].

I understand the purpose of the project is to determine [insert purpose of research].

The primary activity at [Name of School] will be [list all research activities to be

conducted at the site]. The following students are eligible to participate: [describe

participants i.e. grade, class].

I understand that [provide a brief description of activities] will occur for [time and

instructions: e.g.: three weeks during normal classroom instruction, and during

students’ regularly scheduled spelling instruction. This is a daily event, with lessons

lasting from 20 to 25 minutes.] I expect that this project will end not later than

[provide an end date].

I understand that [name of researcher] will obtain consent for all [Name of School]

students participating in the study. [Name of researcher] has agreed to provide to

my office a copy of all CSU Channel Islands approved study protocol materials

including the approved consent documents before [s/he] recruits participants on

campus. Any data collected by [name of researcher] will be kept confidential and

will be stored in a secure location per the approved protocol. [name of researcher]

has also agreed to provide to us a copy of the aggregate results of the research.

If the CSU Channel Islands Institutional Review Board has any concerns about the

permission being granted by this letter, please contact me at the [phone number

&/or email address] listed below.

Sincerely,

[signature if submission is original] [name and title of ranking authority as appropriate] [name of

organization] [direct phone &/or email]

Sample Authorization Letter Template