Application to Conduct Research | Ferguson-Florissant School District

Please complete this form in its entirety. If your response is non-applicable, please note NA in the space provided.

Part A: Contact Information

Name of Principal Investigator(s)

Date

Researcher's Organization/Position

Address

Work Phone Number

Home Phone Number

Email Address required

Fax Number

Part B: Research Project

Title of Study

Purpose of Study

Describe the anticipated benefits of the research to Ferguson-Florissant School District

(Please make sure your entry here relates directly to the research questions stated in part D)

List the school(s) where the study will be conducted

State the approximate number of possible participants

Will there be any expenses expected to be paid by Ferguson-Florissant School District? If yes, please explain and indicate whether the project is grant funded in part or whole.

List the facilities you will need at each school

(i.e. rooms, computers, tables, chairs, etc.)

Part C: Participant Recruitment

Have you had any contact with the school(s) to be involved?

Yes

If yes, with whom did you speak and what was the outcome?

(Please attach written confirmation in part F)

If no, how will you request participation from the school(s)?

Describe the specific procedure to be used to select participants

How will permission to participate (parents, students, educators, others) be obtained?

How will you ensure participants' anonymity and/or confidentiality?

How much school time will be necessary for the participants to conduct this study?

If no school time will be used, please explain

Part D: Research Methods

List all research questions

Briefly describe the data to be collected

Briefly describe the methods used to analyze data and answer the stated research questions

Describe or attach the instruments, forms, questionnaires, or tests to be used to collect data. Explain how they relate to the study

If applicable, who will be responsible for administering tests or questionnaires?

How, when, and to whom will you report the results of the study?

Expected completion date of final report

Do you plan to submit the results for publication? If so, where?

List the names of ALL personnel that will have access to FFSD students and/or schools

(Separate each name with a comma)

Part F: Attachments

Please attach the following files:

A copy of all questionnaires, forms, tests, waivers, permission forms (parents, educators, other), and/or any other communication to be distributed to participants or their parents/guardians
A two to five page proposal that includes the following information:
1. Title of research project
2. Purpose of the research project including how the project may inform FFSD
3. Research questions and hypotheses
4. Description of data that you are requesting
5. Method of analysis that will be used to answer research questions
6. Describe the proposed dissemination of results including to whom and timetable
Evidence that the principal investigator is a qualified researcher. This requirement can be met by submitting a resume or a curriculum vitae that demonstrates a research background commensurate with the proposed project. Peer reviewed publications can also be submitted to meet this requirement.
Letter(s) of agreement from participating school(s) if available
IRB approval form from sponsoring institution if available

Part G: Statement of Researcher

In submitting this application, I assure Ferguson-Florissant School District (FFSD) that I will conduct the research in all respects according to the conditions under which this application may be approved, including district policy on educational research. In compliance with the Family Education Rights and Privacy Act of 1974, I assure the district that identifiable data collected for this study will be kept confidential. I further assure that upon completion of this research, I will provide an electronic copy of the final report(s) to the Ferguson-Florissant School District's approving authority and consent to said documents being posted on the FFSD website in consideration for FFSD support of approved research efforts. Failure to provide final report(s) to FFSD may result in future denial of research related requests.

Part H: Affidavit of Nondisclosure

In submitting this application, I do affirm that when given access to Ferguson-Florissant School District (FFSD), FFSD dataset(s), or FFSD file(s) related to the above named research project, I will

keep all student, teacher, and school information confidential, including individual student scores;
not release any data or data subset obtained in connection with my participation in the above named project to any individual or party; and
conduct the research in all respects according to the conditions under which this research project's application may be approved, including district policy on educational research. In compliance with the Family Education Rights and Privacy Act of 1974, I assure the district identifiable data collected for this study will be kept confidential.