Request to Conduct Research in the Lower Merion School District
Cover Page
TITLE OF STUDY:
Date of Submission:
SECTION 1: Researcher Details
Name of Person Submitting Request:
Are you an employee of LMSD? Yes No If yes, in what role?
Principal Investigator (PI)/Researcher
Name:
Title/Role:
Organizational/School Affiliation:
Address:
Phone:
Email: / Correspondent (if other than PI/Researcher)
Name:
Role:
Organizational Affiliation:
Address:
Phone:
Email:
SECTION 2: College/University Enrollment Status
  1. Are you currently a student enrolled in a degree program? Yes No (Skip to Section 3)
  2. Are you conducting the study as part of a graduation requirement? Yes* No
*If yes, what degree? *Granting institution? *Expected graduation date?
  1. Are you conducting this study in response to a course assignment? Yes* No
*If yes, what is the course title and name of the institution?
*Attach the course syllabus and assignment description.
SECTION 3: Data Collection
  1. Will you be collecting new data? Yes No (Skip to Section 4)
  2. Who will you be collecting data from? Check all that apply:
Students Teachers Administrators Staff Parents Other
  1. What methods will you use to collect data?
Surveys Observations Interviews Testing Artifacts Other
SECTION 4: School/s Involved
Which of the following schools (their personnel or students) will be involved in the proposed study? Check all that apply.
Elementary / Middle / High
Belmont Hills
Cynwyd
Gladwyne / Merion
Penn Valley
Penn Wynne / Bala Cynwyd
Welsh Valley / Harriton
Lower Merion
SECTION 5: Request for Existing Data
  1. Are you requesting access to existing data? Yes No (Skip to Section 5)
  2. What dataset/s are you requesting?

  1. Datasets will be provided as a flat .csv or .xlsx file containing only the variables needed to conduct your research. List the variables you will need to complete your study.
  1. What procedures will you use to safeguard the dataset?
  1. What will you do with the dataset once your study has been completed?

SECTION 5: PPRA/FERPA
Does the study involve sensitive information as outlined under PPRA/FERPA? Yes* No
*If yes, please explain.
SECTION 6: ATTACHMENTS
Check if attached:
Study proposal as outlined in LMSD R244
IRB Application and Approval
Consent/Assent/Information Forms (Check here if not applicable: )
Protocols (Check here if not applicable: )
Recruitment materials (Check here if not applicable: )
Course syllabus and assignment (Check here if not applicable: )
If any of the required attachments are not included, please explain.
To submit your request for review, send this cover sheet and all attachments as a single PDF file to:
  • Mr. Robert Copeland, Superintendent, c/o Denise LaPera at ; and
  • Dr. Kristina Ayers Paul, Research Review Panel Chair, at
Questions? Contact Dr. Kristina Ayers Paul by email at or phone at 610-645-1941.

Version 2/24/17