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Series 801.9P - Request to Conduct Research in District 196

Adopted: September 1990
Revised: August 2009


Name                                                                     Phone                                      

                            (please print)

Email                                                                    Fax                                          


Title of research project                                                                                          

Research institution                                                                                               

School(s) or populations being studied                                                                     

Anticipated beginning date                                                Ending date                    

On a separate sheet of paper, describe:

  • Purpose of research;
  • Planned use of results;
  • Your qualifications;
  • How the rights and privacy of human subjects will be protected, and
  • How the research will benefit District 196 and/or will contribute to the advancement of education in general.

2. Attach all curriculum, forms, handouts, letters, etc. you plan to use in the study.


  signature                                                               date


Request approved                               


Request denied                                   

Date request received




Does this research require access to private identifiable student data?   ❏ yes    ❏ no

If yes, the study must be for the purposes of developing, validating or administering predictive tests, administering student aid programs or improving instruction, and the researcher and the district must enter into an agreement pursuant to section 2.5 of 801.9AR, Use of Students, Employees and /or District Data for Research by completing page 2 of this procedure.







  signature of director                                                date


c:    Superintendent

       Principal(s) affected

        District director(s) affected



Note: This agreement is only necessary if the Researcher requires access to
private, personally identifiable student data


This Agreement to Conduct Research in District 196 is made between Independent School
District 196 and _________________________________________ (“Researcher”). The purpose of
this Agreement is to allow Researcher to conduct research using student data, subject to
certain limitations described in this Agreement. The parties agree as follows:

1.      Purpose – The purpose of the research is to (check one): 

   ❏ develop, validate or administer predictive tests; or

   ❏ administer student aid programs, or

   ❏ improve instruction.

2.      Use of data – The research will require the Researcher to access the following types of student or parent data: (describe the nature and scope of data to be accessed by the researcher




Student or parent information will only be used as necessary to meet the purpose of the research.


3.      Term – The term of the research project will be: (describe the duration of the project)                                                  


4.      Privacy – The Researcher understands and agrees that student information is classified as private data under the law and the Researcher agrees to conduct the research in a manner that does not permit personal identification of students or parents by anyone other than the Researcher or those within the Researcher’s organization with legitimate professional interest in the information. All data collected from District 196 shall be governed by the Minnesota Government Data Practices Act and, if applicable, by the federal Family Educational Rights and Privacy Act (FERPA) and the Researcher agrees to comply with these laws.  The Researcher also agrees to destroy or return to District 196 all personally identifiable student or parent information collected by the Researcher when the information is no longer needed for the purposes for which the research was conducted, in no event later than one year after the conclusion of the term of this Agreement.  The Researcher’s obligation to return or destroy data shall survive the termination of this Agreement.

5.      Incorporation of Documents. The parties agree that Procedure 801.9P and its attached documentation shall be incorporated into and made a part of this Agreement. 

Independent School District 196                 [Name of Researcher/Organization]



signature of director                                      title ___________________________

date __________________________                   date ___________________________