SRM INSTITUTE OF SCIENCE AND TECHNOLOGY, KATTANKULATHUR-603203

INSTITUTIONAL CONSENT FORM

Place:
Date:
From
Parishadh Kumar. A,
MOT- III Semester (Orthopaedics),
SRM College of Occupational Therapy,
SRM Institute of Science and Technology,
Kattankulathur-603203.

Through
The Dean,
SRM College of Occupational therapy,
SRM Institute of Science and Technology,
Kattankulathur-603203.
To

Subject: Request for permission regarding dissertation work.

Respected Sir/Madam,
I Parishadh Kumar. A, pursuing my Master Degree in Occupational Therapy (MOT-
Orthopeadics) at SRM Institute of Science and Technology, Kattankulathur. As a part of my Post
graduate program, I am doing my dissertation work titled as, “EFFECTIVENESS OF
OCCUPATIONAL THERAPY INTERVENTION ON OCCUPATIONAL PARTICIPATION
AND RISK OF FALLS IN MIDAGE GROUP PEOPLE WITH OSTEOARTHRITIS”. As a part
of the data collection for the study, I would need samples for the same.
I assure you that there is no risk in the participation of these individuals in this study. I hereby kindly
seek your permission and cooperation to collect data.
Thanking you in anticipation of your kind support towards the scientific development at this field of
Orthopeadics.
With warm regards,

Mr. Parishadh Kumar. A Mrs. Grace Lydia Sarojini.D Dr. U. Ganapathy Sankar Ph.D.,
MOT- III Semester Vice Principal, SRMCOT Dean, SRMCOT