ࡱ> C j!bjbjnn ; h hkP P 8.f0z:(///////$25 0 0 0F//,h .P'vSdj7-/600f0G-<6<6 . .&<61.o^L 0 0Xxf0<6P X :   Application to Conduct Research in һ District Please complete this form in its entirety (use as much space as necessary). If your response is non-applicable, please note NA in the space provided. When complete, email this form and all required documents designated in section F to: Dwayne D. Schmitz, Ph.D. Chief Institutional Effectiveness Officer, һ District 2413 LaPorte Ave. Fort Collins, CO 80521 (970) 490-3693 (Office); (970) 490-3001 (FAX)  HYPERLINK "mailto:jamesd@psdschools.org" dschmitz@psdschools.org Information and materials submitted in this application may be considered public records subject to disclosure under the Colorado Open Records Act ("CORA"), C.R.S. 24-72-200.1 to -205.5. The Applicant must specifically identify information and materials it believes are confidential and not subject to disclosure under CORA including a citation to the section of CORA and any other relevant law under which Applicant believes they are confidential. The District, not the Applicant, shall determine whether information and materials so identified will be withheld as confidential, but will inform the Applicant in advance of disclosure to give it an opportunity to take legal action to protect its interests vis--vis the party making the CORA request. Part A: Contact Information Name of Principal Investigator(s): Date: Researchers Organization/Position: Address: Work Phone #: Home Phone #: E-mail Address: Fax #:  Part B: Research Project Title of Study: 1. Purpose of Study: 2. Describe the anticipated benefits of the research to һ District: (Please make sure your entry here relates directly to the research questions stated in part D and you are strongly encouraged to have reviewed the  HYPERLINK "https://sites.google.com/a/psdschools.org/research-documents/home/research-partnerships" Current Areas of High Research Interest in һ District document and explicitly refer to specific areas of high research interest that your proposed research will inform.) 3. List the school(s) where the study will be conducted: 4. State the approximate number of possible participants: 5. Will there be any expenses expected to be paid by һ District? If yes, please explain and indicate whether the project is grant funded in part or whole. 6. List the facilities you will need at each school (i.e. rooms, computers, tables, chairs, etc.):  Part C: Participant Recruitment 1. Have you had any contact with the school(s) to be involved? YES / NO If yes, with whom did you speak and what was the outcome? (Please attach written confirmation.) If no, how will you request participation from the school(s)? 2. Describe the specific procedure to be used to select participants: 3. How will permission to participate (parents, students, educators, others) be obtained? 4. How will you ensure participants anonymity and or confidentiality? 5. How much school time will be necessary for the participants to conduct this study? 6. If no school time will be used, please explain:  Part D: Research Methods 1. List all research questions: (Please expand this list as necessary and write questions such that they are researchable.) (a) (b) (c) (d) 2. Briefly describe the data to be collected: 3. Briefly describe the methods used to analyze data and answer the stated research questions. This list should provide a match for each of the research questions listed above: (a) (b) (c) (d) 4. Describe or attach the instruments, forms, questionnaires, or tests to be used to collect data. Explain how they relate to the study: 5. If applicable, who will be responsible for administering tests or questionnaires? 6. How, when, and to whom will you report the results of the study? 7. Expected completion date of final report: 8. Do you plan to submit the results for publication? If so, where?  Part E: Research Personnel Names of ALL personnel that will have access to PSD students and/or schools:  Part F: Attachments Please attach the following to this application: A copy of all questionnaires, forms, tests, waivers, permission forms (parents, educators, other), and/or any other communication to be distributed to participants or their parents/guardians Letter(s) of support from participating school(s) or department heads if available IRB approval form from sponsoring institution if available. (Note: This is not required by PSD for the approval process to be initiated, but PSD appreciates a copy of this document when/where available.) Part G: PSD as needed requirements: Background checks for researchers: If research staff will be present at PSD sites, please sign up each researcher (assistants, etc.) as a volunteer at each school site where they will be physically present while students are also present on the PSD campus. Individual schools will guide researchers through their process for completing the volunteer process. Background checks are part of the normal volunteer process within PSD and should not incur a cost to the individual. Documentation demonstrating expertise in the proposed area of research and with the proposed statistical tools when complex analyses are included in the research plan. Part H: Statement of Researcher: In submitting this application, I assure һ District (PSD) that I will conduct the research in all respects according to the conditions under which this application may be approved, including district  HYPERLINK "https://sites.google.com/a/psdschools.org/research-documents/home/research-partnerships" policy on educational research. In compliance with the Family Education Rights and Privacy Act of 1974, I assure the district that identifiable data collected for this study will be kept confidential. I further assure that upon completion of this research, I will provide an electronic copy of the final report(s) to the һ Districts approving authority and consent to said documents being posted on the PSD website in consideration for PSD support of approved research efforts. Failure to provide final report(s) to PSD may result in future denial of research related requests. 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