Adult Supervisor Form 1.2

(Required for all Pojects)


 

Student's Name ___________________________________________

Title of Project ___________________________________________

 

To be completed by the Adult Supervisor (Please Print)

 

Name ___________________________________________

Position ___________________________________________

Address ___________________________________________

Phone (w) ________________ (h) ________________

(Fax( ________________ (email) _______________

 

EITHER

I have reviewed the research proposal and am qualified in the techniques required by this student. Either I have the necessary qualifications prior to the start of experimentation. And will take direct responsibility for any safety and ethics concerns for this project in that I will provide direct supervision.

 

Adult Supervisor (Print) (Sign) Date

OR

 

I have reviewed the research proposal and am not qualified in the techniques required by this student prior to the start of experimentation. Therefore will take responsibility for the student in that I will make the arrangements for a qualified person to provide adequate supervision.

 

 

Adult Supervisor (Print) (Sign) Date