Frederick County Public Schools<br>Application to Conduct Research

Frederick County Public Schools
Application to Conduct Research

*No research will be conducted prior to approval.*

Section 1: Primary Research Applicant Contact Information
1. Applicant Name 1. Applicant Name First Last
2. Research Affiliated Institution/Organization
3. Address 3. Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
4. Email Address
5. Home Phone 5. Home Phone - ### - ### ####
Work Phone Work Phone - ### - ### ####
6. Are you currently a FCPS Employee?

6. Are you currently a FCPS Employee? Yes No Former FCPS Employee
If yes or former employee, provide your FCPS role and location
Section 2: Other Persons Involved with the Research
7. Name 7. Name First Last
Title/Affiliation
8. Name 8. Name First Last
Title/Affiliation
Section 3: Qualifications of Researcher
9. Is your research for an educational degree program?

9. Is your research for an educational degree program? Yes, masters Yes, doctoral No
Degree or major on which you are working
If not for a degree program, please specify other
10. Years of work experience in this field
Section 4: Research Purpose
11. Name of Study
12. Purpose of Study
13. Describe the benefits of the research to FCPS
Section 5: Research Design/Procedures
14. Indicate the target population(s) and proposed data/data collection methods in your research.

Students

14. Indicate the target population(s) and proposed data/data collection methods in your research.

Students Postsecondary Data Analysis (specify) Surveys Interviews/Focus Groups Observations Document Review Other (specify)
School Principal

School Principal Postsecondary Data Analysis (specify) Surveys Interviews/Focus Groups Observations Document Review Other (specify)
Teachers

Teachers Postsecondary Data Analysis (specify) Surveys Interviews/Focus Groups Observations Document Review Other (specify)
Parents

Parents Postsecondary Data Analysis (specify) Surveys Interviews/Focus Groups Observations Document Review Other (specify)
Central Office

Central Office Postsecondary Data Analysis (specify) Surveys Interviews/Focus Groups Observations Document Review Other (specify)
Other

Other Postsecondary Data Analysis (specify) Surveys Interviews/Focus Groups Observations Document Review Other (specify)
If you responded "Postsecondary Data Analysis" or "Other" in any lines above, please specify below.
15. School(s) of Interest

15. School(s) of Interest Elementary Middle High Not applicable Other, specify
If Other selected, please specify
If specific schools are included in your research, please indicate which schools
16. Provide additional information describing your targeted populations for your study (e.g., number targeted for your sample, targeted grades, special services, or demographics, etc.)
17. Duration of research project
18. Estimate the time required of research participants (students, teacher, and other school personnel involved.)
19. Indicate the research materials that are included with your research application.

19. Indicate the research materials that are included with your research application. Detailed research protocol (includes purpose of research, research questions, recruitment, methods, data privacy/security, data analysis, and reporting) Copy of IRB approval (If not included, please explain below) Consent form(s). No research project requiring home/family information or indentification of individual students by name or code shall be approved without requiring informed parental consent. At minimum, consent forms should include a detailed explanation of the research and participant's involvement, benefits/risks, safeguards and confidentiality procedures, participant's voluntary choice to participate or withdraw, opportunity to receive copy of results, and contact to ask questions Copy of survey(s) Copy of interview/focus group protocol or guide Other, specify in space below
If IRB approval not included, please explain
Other included information
Section 6: Additional Information
20. Please provide any additional information regarding your research
Section 7: Signature
Signature - type your name in the box below as your signature
form is automatically dated on submission
Affirmation: Signature

Affirmation: Signature For purposes of this form, my typewritten name is considered my signature.
Affirmation: Collection of Data

Affirmation: Collection of Data I understand that this application does not constitute an approval of the study for collection of data in the FCPS system.
Affirmation: Policies and Procedures

Affirmation: Policies and Procedures I have read and understand the policies and procedures outlined in FCPS Regulation No. 200-41.
Section 8: Status of Request

To be completed by FCPS staff only.
Rendered Decision

Rendered Decision Approved Conditional Approval Denied
Name of Reviewer Name of Reviewer First Last
Date of review Date of review / MM / DD YYYY
Alignted to FCPS Aspirational Goal(s)

Alignted to FCPS Aspirational Goal(s) Goal 1 Goal 2 Goal 3 Goal 4 Goal 5

Frederick County Public SchoolsApplication to Conduct Research

Frederick County Public SchoolsApplication to Conduct Research

Section 1: Primary Research Applicant Contact Information

Section 2: Other Persons Involved with the Research

Section 3: Qualifications of Researcher

Section 4: Research Purpose

Section 5: Research Design/Procedures

Section 6: Additional Information

Section 7: Signature

Section 8: Status of Request

Frederick County Public Schools
Application to Conduct Research

Frederick County Public Schools
Application to Conduct Research