Research & Data Request Form

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.

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