Research & Data Request Form

Full Name

Email Address

Role/Position

Organization/School

Research Request Type

Administrative Data Request (already existing data i.e. grades, test scores, attendance, etc.)

Human Subjects Research (new research conducted via focus groups, surveys, etc.)

Title of Research Study

Proposed Start and End Date of Research

Purpose of Request

What is the "question" you are attempting to answer by making this request?

Details of Request

Provide details of your request. This is the section that should include specific information about the data you are requesting and/or research you are hoping to obtain/complete.

Data Usage, Storage, and Disposal Plan

How do you plan to utilize the requested data, store it securely, and after what timeframe will you dispose of the data provided?

Requested Due Date?

Attachments

Please include any relevant attachments. If you are submitting a Human Subjects Research request you must include the following:

Letter of IRB approval or exemption
Clearances (PA Criminal Background, PA Child Abuse, FBI Fingerprint) if requestor will have any contact with students
Recruitment method and materials (if applicable)
Informed consent forms
Interview/Focus Group/Observation protocols (if applicable)
Survey/assessment (if applicable)

If required attachments are not submitted your application will NOT be reviewed.

Add Attachments

Drop your files here

Send me a copy of my responses

Report Abuse