This confidential self-assessment form is being provided to the CARU staff for the sole purpose of this request that the site(s) listed below be accepted into the Children's Online Privacy Protection Act (COPPA) Safe Harbor program. This document will not be shared or used with anyone outside the CARU staff for any other purpose without the written consent of the applicant.

This form is not interactive. Please print to paper and fill out.

Please note: If you are seeking Safe Harbor status for multiple sites and information collection practices differ significantly at the sites, it is preferable to submit separate forms to facilitate the review.

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