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SFUSD Research, Planning, and Assessment Dept.REVISED March 2018

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Research, Planning, and Assessment Department

Application to Conduct Research in the San Francisco Unified School District

(SFUSD)

Title of Research Study: Click or tap here to enter text.

Primary Researcher: Click or tap here to enter text.

Research Organization: Click or tap here to enter text.


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Attachments and Application Submission Checklist

Below is a list of all Forms included in this application package. Please use this as a checklist of what you are including when you submit your application.

☐ FORM 1a: Executive Summary 3

☐ FORM 1b: Application to Conduct a Research Study in SFUSD 4

☐ FORM 2a: Request to Administer a Survey, Interview, or Other Assessment in SFUSD 9

☐ FORM 2b: Criminal Background Check, Subsequent Arrest Notification, Tuberculosis Clearance Certification 12

☐ FORM 3: Request for SFUSD Administrative Data to Use in a Research Study 13

☐ FORM 3a: Specific records or data elements 16

Additional attachments included in your submission:

☐ Consent / Assent Forms

☐ Survey / Interview / Assessment Instruments and Protocols

☐ Institutional Review Board (IRB) Approval

☐ Memorandum of Understanding (MOU) or Contract

☐ Letter of Support from Thesis Advisor

☐ Other:Click or tap here to enter text.


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FORM 1a: Executive Summary

Study Title: Click or tap here to enter text. PI: Click or tap here to enter text. Research Org.: Click or tap here to enter text._

[Note to researchers: This page will serve as the project overview for internal district administrators considering supporting or participating in your proposed research study. Please consider their perspective and be succinct, avoid jargon, and focus on addressing their needs.]

Abstract (Max. 100 words)Click or tap here to enter text.

Abbreviated procedures : Describe the expectations for personnel who would be involved in supporting the study, especially site staff. Include the number of staff and students impacted, as well as the nature and extent of impact. (Max. 100 words)

Click or tap here to enter text.

Usefulness of research : Describe how you will ensure and document the use, impact, and sustainability of applying the research results to practice. What are possible actions by which the district might use the research results to shape practice and policy for positive impact? How would this impact be sustainable?


SFUSD Research, Planning, and Assessment Dept. REVISED March 2018

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FORM 1b

Application to Conduct a Research Study in SFUSD

Date of submission: Click or tap here to enter text.


Name and Title of PrimaryResearcher: Click or tap here to enter text.

Organization: Click or tap here to enter text.

Address:

City:Click or tap here to enter text. State:_Click or tap here to enter text.__ Zip:

Telephone:Click or tap here to enter text. Email Address Click or tap here to enter text.

Grant Agency (if applicable) Click or tap here to enter text.

Are you employed by SFUSD? Yes ☐ No ☐

If yes, please list your school or department: Click or tap here to enter text.

Please indicate if this project is:

Yes No

☐ ☐ Part of your master’s thesis

☐ ☐ Part of your doctoral dissertation

☐ ☐ Renewal of previous research application, dated

☐ ☐ Part of existing contract with SFUSD, dated

☐ ☐ Part of existing MOU with SFUSD, dated

What are the research study's projected/proposed start and end dates? Note: Projects require annual renewal.

Start Click or tap here to enter text. End Click or tap here to enter text.

Expected dates for reporting interim and final findings Click or tap here to enter text.


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Description of the Research Study

FORM 1b

1. Research Question:a. What problem is the study intended to help solve? What are the theoretical and empirical

motivations for the study? Max. 200 wordsClick or tap here to enter text.

b. Alignment : Which district goals (from Vision 2025 (http://bit.ly/sfusd2025) and the district’s strategic plan(http://bit.ly/sfusd_tltl)) does your research best support? Check up to three.

Graduate Profile Classroom Strategies School Strategies Central Office Strategies☐ Content Knowledge☐ Creativity☐ Career and Life Skills☐ Global, Local & Digital Identity☐ Leadership, Empathy, and Collaboration☐ Sense of Purpose and Sense of

Self

☐ Instructional Core☐ Dimensions of Teaching and Learning

○ Agency, Authority, and Identity○ Access to Content○ Role of Assessment to Inform Instruction

☐ Implementation of SFUSD’s Core Curriculum

○ Safe and Supportive Learning Climate

☐ Family-School Partnerships

☐ Leadership○ Instructional Leadership

○ Inclusive-Facilitative Leadership○ Operational-Managerial

☐ Instructional Guidance☐ Professional Capacity Systems

○ Teacher Collaboration○ Instructional Coaching○ Professional Development

☐ Student-Centered Learning Climate☐ Parent-School-Community Ties

☐ Supporting School Improvement & Transformation

☐ Teaching and Learning☐ Safe and Supportive Schools☐ Talent and Culture

○ Invest○ Grow○ Build

☐ Family Empowerment and Community Partnerships☐ Resource Management and Impact

2. Describe your proposed argument for how you will answer the research question. (Max. 250 words)Click or tap here to enter text.

http://bit.ly/sfusd_tltl

http://bit.ly/sfusd2025


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3. Research design : Describe your sampling, data collection, and analysis plans.Click or tap here to enter text.

FORM 1b


Page PAGE 7 of 16

FORM 1b4. What conversations have you had with SFUSD personnel about the research? With whom, and when?

How did the idea for the research project originate?Click or tap here to enter text.

5. Plan for Internal Research UseAll research results at SFUSD must be reported clearly and translated into potentially useful actions.

Describe your plan for communicating the progress of your research to the relevant district partners, including deadlines by when you propose to communicate the progress.


On the signature page 8, please indicate your commitment to report and communicate results for concrete and useful action for the district according to these plans.

6. Plan for External Research UseIf you plan to share your results with any audience external to SFUSD, please describe your reporting plan identifying how and to whom those findings will be presented and disseminated.



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FORM 1: Application to Conduct a Research Study in SFUSD – Signature Page


Indicate all additional forms and appendices that are being submitted as part of this application:

☐ Form 2a: Request to Conduct a Survey, Interview, Observation, or Other Assessment in SFUSD) Survey / Interview Protocol / Assessment: Click or tap here to enter text.

I will obtain active parental consent for the release of student data for all students from whom I will be collecting data. I have submitted all consent forms with my application. Check one:☐ YES ☐ N/A

☐ Form 2b: Criminal Background Check, Tuberculosis Clearance (required for site access). If there are any changes to research personnel visiting school sites, I will submit a revised Form 2b reflecting these changes.

☐ IF WAIVING FORM 2b: I certify that the Research Organization’s employees, agents or volunteers will HAVE ONLY LIMITED OR NO CONTACT with District students (as defined by District) in the performance of this Agreement.

☐ Form 3: Request for SFUSD Administrative Data to Use in a Research Study

☐ Appendices: Click or tap here to enter text.

By marking the boxes below, I certify that:

☐

I promise to collaborate with district leaders to ensure that research findings provide actionable implications and useful impact for the district. This will include a written report of my research findings to the Research, Planning, and Assessment Department at the San Francisco Unified School District ≥14 days prior to submitting any reports for publication. I will make sure all tables and figures containing data from SFUSD include the source, date, and definition of the data described in the report.

☐ The research project will be conducted and communicated as described herein. I have read and agreed to the provisions of the “Guidelines for Research in San Francisco Unified School District.”

Click or tap here to enter text. Primary Researcher’s Signature

Name + Title (please print)

Date

FOR OFFICE USE ONLY DO NOT WRITE BELOW THIS LINE

APPROVAL

Supervisor, RPA: Signature

Name (please print)

Date

Division of School Operations: Signature

Name (please print)

NON-APPROVAL

Date

Supervisor, RPA

Name (please print)

Date

Division of School Operations: Signature

Name (please print)


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Date

SFUSD Research, Planning, and Assessment Dept. REVISED March 2018 of 16

FORM 2a

Research, Planning, and Assessment Department

Request to Conduct a Survey, Interview, Observation, or Other Assessment in SFUSD

Please attach ALL final instruments or protocols, including translations, and any supplementary materials and documentation that will assist in assessing their validity and reliability. Any subsequent revisions must be reviewed and approved before they may be administered.

When answering the following questions, refer to the specific goals and objectives of your research and the context in which this survey, interview, observation, or other assessment fits within the overall goals and objectives of your study.1. Purpose and Justification

a) What are the goals and objectives of conducting this survey, interview, observation, or other assessment?Click or tap here to enter text.

b)How are the participants likely to benefit from participating in this survey, interview, observation, or other assessment?



2. Study Samplea) What is the sample size and how did you determine it?


b) Who is being surveyed, interviewed, observed, or assessed? How did you determine this sample?

i. Please describe in detail your site selection criteria, including characteristics of participants.


ii. Please complete the following information about all sites and participants in your proposed study: ☐ ☐ ☐ ☐ ☐

Total number of schools: Click or tap here to enter text. School Level: Pre-K K-5 K-8 MS HS

Total number of students: Click or tap here to enter text. Grades: From Choose an item. To Choose an item.

Total number of teachers: Click or tap here to enter text. Other: Click or tap here to enter text.Total number of administrators: Click or tap here to enter text.

Others: Click or tap here to enter text.

iii. Please list the specific schools where you are requesting access.Click or tap here to enter text.

3. Data Collection CyclePlease submit an outline of your data collection cycle, including administration procedures and dates.

Time requirements of the data collection

Total time at each individual school: Click or tap here to enter text.

(For multicycle research, indicate times for each cycle, e.g., year 1, year 2, year 3, for the following:)

Total time per student, per cycle: Number of sessions:

Length of sessions: Interval of sessions:

Total time with staff: Number of sessions:

Additional explanations: Click or tap here to enter text.

Click or tap here to enter Click or tap

Click or tap here to enter

Click or tap

Click or tap

Click or tap here to enter


4. Agreement to Obtain Active Parental Consent to the Release of Student Data

SFUSD requires active parental consent/assent before obtaining primary information from students (e.g., surveys, interviews, observations, etc.) or disclosing personally identifiable information for reasons that go beyond studies to improve instruction. Consent forms must inform the parent/guardian:

a. of the purpose of the study;b. of what existing data about the students are being requested and/or what new data about the students

will be collected and how it will be collected;c. how information about students will be used and disseminated;d. that all research instruments are available for review including instruments for primary data collection

such as surveys, focus group protocols, interview protocols, or observation protocols ; ande. of how to contact the researcher if the parent or guardian has any questions.

Sample consent forms are available on the Research, Planning, and Assessment Data Center. Please submit consent/assent forms with your research application if necessary.

Please indicate your certification of obtaining active parental consent on the signature page (p. 8).

5. If parents or guardians do not read English, the form must be translated into a language they are able to read. Please describe your plan for translating materials when necessary for families and students who do not speak/read English.


6. Extent of Access to School Sites during the course of the research:a. Will any research personnel be visiting a school site or interacting with any students?

☐ YES ☐ NO

Please describe details of site visits and interactions with students, including frequency and depth of interactions.


b. If yes:i. Is there a possibility that the researcher may be alone with a student or group of students at

any time? ☐ YES ☐ NO

ii. Is there a possibility that a student may come to perceive the researcher as a trustworthy adult (e.g., due to repeat visits, even if they do not involve direct student contact)?

☐ YES ☐ NO

iii. Is there a possibility that a student may develop a relationship of trust with a researcher (e.g., through extensive interaction)?

☐ YES ☐ NO

If you answered "YES" to any of the above questions in part B, you will need to complete Form 2b before any personnel will be granted site access. Please indicate your commitment to submit Form 2b on the signature page of Form 1.

Otherwise, please indicate your request to waive Form 2b on the signature page of Form 1.


FORM 2bTitle of Research Study: Click or tap here to enter text.

San Francisco Unified School DistrictCriminal Background Check, Subsequent Arrest Notification, Tuberculosis Clearance

Written Certification Form

To be completed by Research Organization:

Name of Research Organization*: Click or tap here to enter text.

Services to be performed under the Agreement*: PER RESEARCH AGREEMENTSchools/Locations where services are being performed*:

PER RESEARCH AGREEMENT

Term of Agreement*: PER RESEARCH AGREEMENT*Provided for reference only; the research agreement shall control in the event of any conflict of terms with this form.

Research Organization shall check the applicable boxes and fill in the applicable information:

CRIMINAL BACKGROUND CHECK and SUBSEQUENT ARREST NOTIFICATION

1. ☐Research Organization’s employees, agents or volunteers, listed here/attached, will have MORE THAN LIMITED CONTACT with District students (as defined by District) in the performance of this Agreement.INSERT NAMES OF EMPLOYEES AND DATES OF FINGERPRINT CLEARANCE


(Attach and sign additional pages, as needed.)By checking this box, Research Organization certifies that its employees, agents, volunteers noted above/attached have been fingerprinted via LiveScan through the California Department of Justice and the FBI, and the results of those fingerprints reveal that none of these individuals has been arrested or convicted of a serious or violent felony as described in Education Code (“EC”) 45125.1 (citing 45122.1), a sexual offense as defined by EC 44010, or a controlled substance offense as described in EC 44011, and Research Organization certifies that it has requested SUBSEQUENT ARREST NOTIFICATION for these individuals.

TUBERCULOSIS TESTING CLEARANCE

2. ☐ Research Organization’s employees, agents or volunteers, listed here/attached, will have MORE THAN LIMITED OR PROLONGED CONTACT with District students (as defined by District) in the performance of this Agreement.INSERT NAMES OF INDIVIDUALS AND DATES OF T.B. CLEARANCE


(Attach and sign additional pages, as needed.)By checking this box, Research Organization certifies that such individuals have cleared TB testing within the last four years.

Further Certification by Research Organization: “I hereby certify on behalf of Research Organization that the information provided herein is true and accurate. I further agree that during the term of this Agreement, if Research Organization learns of additional information that differs from the responses provided above, including but not limited to assigning new personnel and/or notice of a subsequent arrest, Research Organization will immediately forward this information to District. If Research Organization receives any subsequent arrest notification, I certify that Research Organization will immediately notify District and bar such employee/ agent/ volunteer from performing any services under this Agreement that involve any contact with students.”

Research Org. Signature Date SFUSD Administrator Signature Date Cabinet Member Signature Date


Print name of Authorized Signatory Print name of Administrator Print name of Cabinet Member

Title of Research Study: [TITLE]

FORM 3: REQUEST FOR SFUSD ADMINISTRATIVE DATA TO USE IN A RESEARCH STUDY

According to the Education Code, people who can receive SFUSD data for the purposes of research are:

Organizations conducting research for SFUSD for the purpose of developing, validating, and administering predictive tests, administering student aid programs, and improving instruction.

If your request for secondary or “administrative” data used for the purposes of research fits within the above parameters, please fill out this form.

Please include any supplementary materials that will assist in understanding which data are being requested.

AGREEMENT FOR CONFIDENTIAL DATA EXCHANGE BETWEEN SFUSD AND RESEARCH ORGANIZATION

This Data Exchange and Confidentiality Agreement (“Agreement”) between San Francisco Unified School District (hereinafter referred to as SFUSD), and [RESEARCH ORGANIZATION] (“Research Organization”) describes the research project proposed by Research Organization, and the means to be used by Research Organization to ensure the confidentiality and security of information and data exchanged between SFUSD and Research Organization.

GENERAL TERMS

The Family Education Rights Privacy Act permits the release of personally identifiable student data without prior written parental consent if the release is to “organizations conducting studies for, or on behalf of, educational agencies or institutions for the purpose of developing, validating, or administering predictive tests, administering student aid programs, and improving instruction, if such studies are conducted in such a manner as will not permit the personal identification of students and their parents by persons other than representatives of such organizations and such information will be destroyed when no longer needed for the purpose for which it is conducted.” 20 USC 1232g(b)(1)(F).

A. PURPOSE

Summarize the purpose of the research.

[PURPOSE]

To accomplish the purpose described above, Research Organization will seek to answer the following research questions:

[RESEARCH QUESTIONS]

B. SCOPE Briefly describe the scope of the research. Who is being studied (which schools, students, staff, etc.)? Which time period (which school years)? Specific details on the sample will be clarified in Attachment A.

[SCOPE]


C. NATURE OF DATA To address these questions, Research Organization requests the specific SFUSD records or data listed in Attachment A.

D. TRANSFER OF DATA SFUSD and Research Organization shall use a secure, mutually agreed upon means and schedule for transferring confidential information. At no time will data be sent by any other means to or from the parties, such as through cloud-sharing services or remotely hosted non-SFUSD FTP sites.

Describe method for exchanging data.[METHOD OF DATA TRANSFER]

E. PERIOD OF AGREEMENT This Agreement shall be effective when signed by both parties, and will terminate on [DATE] unless terminated earlier by either party pursuant to Section IV. TERMINATION.

RESEARCH ORGANIZATION RESPONSIBILITIES Research Organization agrees to the following confidentiality statements:

A. Research Organization acknowledges that these data are confidential data and proprietary to SFUSD, and agree to protect such information from unauthorized disclosures and to comply with all applicable District, Local, State and Federal confidentiality laws and regulations including but not limited to the California Education Code and the Family Education Rights and Privacy Act (FERPA).

B. Research Organization shall designate [NAME], [TITLE], as the person responsible for the security and confidentiality of the data and will notify SFUSD immediately in writing of any change in designee.

C. Research Organization will use appropriate safeguards to prevent the use or disclosure of the information other than as provided by this data use Agreement.

D. Research Organization shall instruct all staff with access to confidential information about the requirements for handling confidential information, and require each person who will have access to confidential information to sign an agreement to comply with the confidentiality provisions of this Agreement, and any other confidentiality requirements of the Research Organization.

E. Research Organization shall not assign this Agreement or any portion thereof to a subcontractor or other third party without the prior written consent of SFUSD, and any attempted assignment without such prior written consent in violation of this Section shall automatically terminate this Agreement.

F. Research Organization agrees that the research shall be conducted in a manner that does not permit personal identification of parents and students by individuals other than representatives of the Research Organization that have legitimate interests in the information.

G. Research Organization will report only aggregate data and will not report any individual data, nor will data be reported in a manner that permits indirect identification of any individual.

H. Research Organization will not contact the individuals included in the data sets without obtaining advance written authorization from SFUSD.

I. Research Organization shall not re-disclose any individual-level data with or without identifying information to any other requesting individuals, agencies, or organizations without prior written


authorization by SFUSD.

J. Research Organization shall use the data only for the purpose described in Section A above. These data shall not be used for personal gain or profit.

K. Research Organization shall keep all information furnished by SFUSD in a space physically and electronically secure from unauthorized access. Information and data shall be stored and processed in a way using current industry standard technology, including without limitation encryption software, so that unauthorized persons cannot retrieve nor alter the information by means of a computer, remote terminal, or other means. No data will be stored on laptop computers or other portable computing devices or media, e.g., flash drives, etc.

L. Research Organization shall permit examination and on-site inspections by SFUSD upon reasonable advance notice for the purpose of ascertaining whether the terms of this Agreement are being met.

M. Research Organization agrees that the confidential data shall be destroyed within 30 days after no longer needed for the purposes for which the study was conducted, and will provide written notification to SFUSD confirming when the data have been securely destroyed.

LIABILITY

Research Organization agrees to be responsible for, and assumes all liability for, any claims, costs, damages or expenses (including reasonable attorneys’ fees) that may arise from or relate to the Research Organization’s intentional or negligent release of personally identifiable student, parent or staff data (“Claims”). Research Organization agrees to hold harmless SFUSD and pay any costs incurred by SFUSD in connection with any Claim. The provisions of this Section shall survive the termination or expiration of this Agreement.

TERMINATION

A. This Agreement may be terminated as follows, after notification via the United States Postal Service (certified mail or registered mail) or recognized overnight delivery service (e.g., UPS, DHL or FedEx): 1. By either party immediately in the event of a material breach of this Agreement by another party.2. By either party after 30 days advance written notice to the other party, for any reason or no reason.

B. The confidentiality provisions of this Agreement shall survive the termination of the Agreement. If this Agreement is terminated by either party for material breach or for any other reason with 30 days written notice, the confidential information shall be returned or destroyed within 7 days of the termination. If the Agreement terminates at the end of the term described in Section D, Research Organization shall return or destroy all confidential information when it is no longer needed for the study. Such return or destruction shall occur within 7 days after it is no longer needed for the study.

C. Destruction of the confidential information shall be accomplished by utilizing an approved method of confidential destruction, including shredding, burning or certified/witnessed destruction for physical materials and verified erasure of magnetic media using approved methods of electronic file destruction.

GENERAL UNDERSTANDING

A. This Agreement contains the entire understanding of the parties and may only be amended in writing signed by the parties.

B. This Agreement shall be governed by and construed under the laws of the State of California.C. Any waiver by any party of the violation of any provision of this Agreement shall not bar any action for

subsequent violations of the Agreement.

____________________________________Research Organization: Signature

[NAME + TITLE] __________ Name + Title

___________Date

DATE


____________________________________SFUSD Research Department: Signature

__________________________Name (please print)

___________Date


ATTACHMENT A: SPECIFIC RECORDS OR DATA ELEMENTS

Please specify:

a. study sample . Identify which school sites and which groups of students and/or staff (grade levels, program participants, etc.).

b. dates of data . Identify the specific time periods from which you need the data (e.g., Fall 2017; 2015-16 and 2016-17).c. specific fields requested (i.e., student name, date of birth, ethnicity, gender, primary language, etc., NOT

“demographic data”). Include a rationale explaining its purpose and use. Please distinguish between variables that are critical to the analyses and variables that could be useful, if available, for adding more nuance to the findings.

For longitudinal, multiple-cohort analyses, include a table clearly specifying grades and school years identifying each cohort and the school years for which data are needed for each cohort.

If it is necessary to link administrative data with other data obtained separately by the research organization, please describe the strategy for linking the data. For example, Research Organization will provide program data for participating students, including enough identifying information to link them unambiguously to student identification numbers. SFUSD will return these data associated with scrambled student identification numbers. Please specify which fields will be used to link records (e.g., email addresses; students’ names and birthdates; etc.).

[DATA RECORDS (sample, dates); DATA FIELDS; RATIONALE]

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