Dearborn City Schools Request to Conduct Research

Dearborn City Schools Request to Conduct Research
Individuals interested in conducting research in Dearborn City Schools must fill out an online application. Requests to Conduct Research will be reviewed by the District's Cabinet. In terms of student submissions, the committee will only accept applications from graduate level students. Please allow a minimum of 15 working days for the preliminary review. Extended processing time may be necessary depending on the time of year. The research guidelines utilized as part of this application are intended to protect the confidentiality and welfare of our students, parents/guardians, and staff members as well as to ensure the integrity and quality of any research being conducted in the district.Please complete the following form and attach any supplemental documents. All documents should be clearly labeled (ex., Consent Form, Satisfaction Survey, Recruitment Letter, Interview Protocol, Data Requested, etc.). All research being carried out at school sites must be conducted under the direct supervision of a certificated administrator or staff member.

Part 1: Applicant Information
Name *

First Name Last Name
Title/Position *
Organization Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Work email *
Work Phone Number *

Area Code Phone Number
Home Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Part 1b: Co-Applicant Information (If no co-applicant, skip to next page)
Co-Principal Investigator

First Name Last Name
Title/Position
Institution/Organization

Part 2: Study Details
Title of Research Study/Project *
Is this a renewal application for a previous study/project? *

Yes No
Is the principal Investigator a ....? (Note: Graduate students must attach a signed letter of support, including a planned use of data, from a faculty advisor) *

Graduate Student Dearborn City Schools Employee Neither of the above
Does the Principal Investigator's organization require IRB approval for this study? *

Yes No
Costs to the district *
Benefits to the district *

Part 3: Study Design (procedures, methods, techniques, instruments)
Recruitment *
Describe how participants will be recruited and selected for this study
Participant Characteristics *
Describe how will participate in the study, participant characteristics, and how many of each group
Tasks *
Describe what tasks are activities the particpants would complete
Location *
Provide details about where the study will take place
Study Timeline *
Provide details regarding the study's begin date, data collection points, anticipated conclusion
Informed consent *
Describe the informed consent process; how will you ensure that subject participation is voluntary

Part 4: Data Collection
Instruments *
Describe the tools you will use to collect data from the participants
Existing data *
If seeking existing data, please describe which data, for whom and time span

Part 6: Special study needs/ arrangements
DPS Administrator support/referral? *
Has a DPS administrator given you preliminary intent/tentative intent to participate in your study? If yes, please explain and attach any relevant documentation (ex., email)
Special needs *
Describe any special needs of the study
Special arrangements *
Describe any special aspects which should be considered in trying to make school arrangements
NOTICE: Dissemination of results *
Copies of reports for all completed studies are required. Please provide a data by wich the abstracts/prints of the research report/results will be provided to the district

Part 7: Checklist and preparation for document upload
Note: Please take a moment to review this checklist to ensure that you have ALL required documents ready to be uploaded before continuing to the submission page
Copy of youth assent forms (at the appropriate reading level) Copy of adult consent forms (at an appropriate reading level) Copy of IRB approval (if required) Copy of recruitment letters, scripts, etc. Copy of survey and/or test instruments Copy of verbal scripts Copy of focus group, interview, and/or observation protocols Copy of research proposal A detailed list of any existing data being requested from the research office

Part 8: Document upload and submission
Upload all supporting documents for your request to conduct research. NOTE: All ASSENT and CONSENT forms must be submitted in Microsoft Word format! The remaining documents can be submitted in either Microsoft Word or Adobe PDF formats.
Upload
By submitting this request to conduct research, I certify that this research application, and the documents contained in my uploaded file(s), are an accurate and complete statement of the nature of my research.

I further understand that submission of this application does not necessarily guarantee approval or renewal, and that the application review process takes a minimum of 15 working days.
Should be Empty:

Now create your own JotForm - It's free! Create your own JotForm