Humble ISD Application for Research

Please type and complete all sections of this form. Return to:

I.General Information:

Application Number:
(Assigned by HUMBLE ISD)
Date Received:
(Completed by HUMBLE ISD)
Date Submitted:
Proposed Project
Starting Date:
Proposed Project
Ending Date:
Project Title:
Overall Project Purpose (e.g., thesis, journal publication):
Major Data Source / Electronic database only_____
Site visits______
Other (Specify)___
Relationship to Humble ISD / Employee__
Former employee__
Continuation of on-going research__
New___
Are you proposing implementation of a program? / ___Yes___ No
If yes, what type of program? / ___Curriculum or Instructional Methods Program (e.g., reading or science instruction using new methods or materials)
___Student Services Program (e.g., pregnancy prevention or student mentoring)
___Professional Development
___Other program Type: ______
If your project will implement a program, please briefly describe it here, and attach a copy of your proposed curriculum or other program materials.
District program approval signatures (HUMBLE ISD use only)
Based on the information/ process described above, the following recommendations are made: / Approval______
Revision and Resubmission______(attach explanation)
Denial______(attach explanation)
______

SignatureDate

II.Main Project Contact Person/Student if class project, thesis or dissertation
Name:
Address:
Phone:
E-Mail Address
III. Project Director/Supervising Professor if class project, thesis or dissertation
Name:
Address:
Phone:
E-Mail Address

IV.Project Overview:

SAMPLE / Number / Description (Grades, Schools, Other Characteristics)
Students
Staff/Others
Parents/Guardians
PARTICIPATION /

Time Required

/ Data Required (New & from School/Central Records)
Students
Staff/Others
Parents/Guardians

COMMENTS (Please attach additional pages, if necessary.)

V.What hypothesis(es) or research/evaluation question(s) is being investigated?

VI.How will you obtain parental/guardian consent for participating students? What consents will be obtained from other participants?

VII.Is this a single study or one of a series planned or contemplated?

VIII.Provide a brief summary of your research or evaluation design, including statistical analysis procedures. If district data sources will be used, please detail your variables and sampling needs.

IX.Use at least three of the most prominent studies, articles, or books from the knowledge base this project addresses to answer the following questions: (Please attach additional pages if necessary.)

  • How will this project contribute to the HumbleIndependentSchool District?
  • How will this project contribute to the field of education or to the area it addresses?

X.Source of project funds:

XI.List data collection equipment and names of survey instruments to be used (attach descriptions of commonly available instruments or copies of researcher-developed or adapted instruments):

XII.Does any of the equipment or any procedure to be used constitute a potential emotional or physical hazard to subjects?

No _____ Yes _____ (If yes, attach explanation.)

XIII.HUMBLE ISD Facilities needed:

XIV.Will research/evaluation assistants collect data? If so, please provide names, job titles and institutional affiliations.

XV. Describe your data stewardship program, including internal controls to protect personally identifiable information and other aspects of the data collection. A data breach can result in the termination of the research agreement in addition to financial responsibility on the part of the researcher to notify and ameliorate the consequences of the breach. The plan should detail your policies and procedures to protect privacy and data security, including the ongoing management of data collection, processing, storage, maintenance, use, and destruction. What steps will be taken to ensure data is secure from unauthorized access? Will individuals accessing personally identifiable information execute affidavits of nondisclosure indicating their training in FERPA policy as well as compliance during the study?

XVI.I agree to submit a copy of my final research report to Humble ISD (via e-mail to ) or via mail to

Director of Accountability and Research

20200 Eastway Village Drive

Humble, Texas 77338

XVII.Assurances:

A.I understand that I am requesting assistance in a research and evaluation project and I am not requesting information pursuant to the Texas Open Records Act. If my request to conduct research and evaluation assistance is granted, I agree to abide by all policies, rules, and regulations of the district including securing written parental permission prior to implementation of my project, and maintaining the confidential nature of records, and the privacy and rights of the individual and school.

This application serves as part of the written agreement under the studies exception of the

Family Educational Rights and Privacy Act (FERPA), under Guidance for Reasonable Methods and Written Agreements. The purpose, scope, and duration of the study as well as information to be disclosed are outlined in this document above. I understand that any changes to these will require an updated research application, which will be subject to a new approval process.

The educational records disclosed will only be used to meet the purposes of the study as detailed above. The study will be conducted in such a manner that does not permit the personal identification of parents and students by anyone other than researchers. Steps will be taken throughout the cycle of the study to ensure the confidentiality of personally identifiable information, including the final report or product using best practices ( see will not be disclosed to other parties without written permission from the district. All personally identifiable information will be destroyed when the information is no longer needed for the purposes of the study. A specific deadline for this disposal will be given in the letter of approval if permission is granted to conduct the study.

Signed:

Main Project Contact Person/Student

B.I have read the Procedures for Research and Evaluation in the Humble Independent School District and understand that supervision of this project and responsibility for a report on its outcome rests with me. I also understand that the privilege of conducting future studies in the HumbleIndependentSchool District is conditioned upon the fulfillment of such obligations.

Signed:

Project Director/Supervising Professor

HumbleIndependentSchool District

Accountability, Assessment, and ResearchRevised Dec. 2015

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