505.51F Conduct Research

APPLICATION FOR PERMISSION TO CONDUCT RESEARCH
ANKENY COMMUNITY SCHOOL DISTRICT

Approval of this form does not imply approval of the course for lane change.

#505.51F Conduct Research                                                                                                         Date ____________________


Any person requesting to conduct research in the District must first get approval. All requests must be submitted directly to the Chief Officer of Academic Services approval. Please allow at least two weeks for review. Type or print this form in duplicate and return one copy to 306 SW School Street, Ankeny, Iowa 50023.

1. General Information
Applicant’s Name ________________________________                       Phone _________________
Address ________________________________________                       Zip Code ________________

Resident of Iowa? ___ Yes ___No Student Teacher? ___Yes ___No

Ankeny Schools Contract Teacher? ___Yes ___No

Sponsoring Higher Education Institution/Agency ______________________________________

Does research relate to curriculum and instruction? _____ Yes: _____ No:

Does the research align with the District’s Curriculum _____Yes ______No


2. Your proposed research project must include the following details:
  • Title of Study
  • Purpose for pursuing research (thesis, advance degree work, personal information, specific data to be collected, etc.)
  • Persons included in research (principal, teacher, students, etc.) and how they will be included, amount of time required of each individual/group.
  • Dates research will be conducted (approximate)
  • Copy of any parent letters, assessment instruments, Human Subject Release Form, etc. (this would be at the discretion of the college/university and District administration).
  • An outline of procedures you will follow in distribution, administration, and collection of instruments requiring staff or student response.
3. Any changes in the original request must be submitted in writing to the Chief Officer of Academic Services prior to research being conducted. If changes are intended to be made in the original request during the research project, the Chief Officer of Academic Services must be notified prior to changes being implemented.

I understand that the granting of permission to pursue this research project in the Ankeny Community School District obligates me to provide and abstract of findings to the Chief Officer of Academic Services and one copy of this abstract to each principal of the building(s) where the project was carried out. I further agree to comply with all conditions described in “Instructions for Requesting Approval to Conduct Research in the Ankeny Community School District.”

Signature of Applicant _____________________________________                                           Date _____________

Signature of Sponsoring Professor / College Instructor ___________________________            Date _____________

Approved:
February 19, 2007

Reviewed:
December 21, 2009
January 19, 2015
December 19, 2016

Revised:
December 21, 2009
January 19, 2015
December 19, 2016