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CLARK COUNTY SCHOOL DISTRICT

RESEARCH REVIEW APPLICATION Instructions

This application packet contains the following documents:

• CCSD Research Review Application Instructions

• CCSD Research Review Application (Parts A, B and C)

• CCSD Application Checklist

• Important Information for Applicants

Please review all documents in the application packet before completing and submitting your application. The application is a Microsoft WORD document. To enter responses, click and begin typing in the area below each question or fill cells in tables. When completing the application, be sure to answer all questions completely while being as concise as possible. If an item does not apply, enter “N/A”.

Submit your application packet via email to cherylk@ at the Department of Research and School Improvement of the Clark County School District. Incomplete applications and applications using a font size smaller than 12 point will not be accepted.

All research applications shall contain the following:

• Parts A, B and C of the application

• Letter of Acknowledgement of a Research Project at a CCSD Facility (if applicable)

• Copies of all data collection instruments and protocols for data collection, including all data collection instructions and recruitment communication

• Assurance Training Certificate[1]

• Informed consent forms for each category of subject

• Assent forms for students (if applicable)

• A copy of the IRB application and letter of approval from the Institution of Higher Education (IHE) (if the applicant is a student or faculty member)

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RESEARCH REVIEW APPLICATION

PART A: APPLICANT INFORMATION & PROJECT IDENTIFICATION

| |

1. Project Title:

2. Duration of Project

|Anticipated Start Date: | |Anticipated End Date: | |

3. Applicant Contact Information

|Name and Credentials (First, Middle, Last): | |

|Mailing Address (if you are a CCSD employee please provide| |

|an address other than your work location): | |

|E-Mail Address: | |

|Telephone Number: | |

Are you employed by the Clark County School District? □ Yes □ No

If yes, please complete the following:

|Position Title: | |

|Work Location Name: | |

|Work Location Number: | |

4. Research is to be conducted as:

| |Part of work duties (CCSD employees only) |

| |An individual only |

| |A faculty member of an institution of higher education |

| |A researcher contracted by CCSD to perform the research |

| |A vendor of products |

| |A student seeking: |□ Bachelors |□ Masters |□ Doctorate |

| |Other (Please identify the organization): | |

5. If your research is to be conducted as a student seeking a degree, please complete sections 5.1 and 5.2 below.

5. Research advisor/director information

|Name (First, Middle, Last): | |

|Degree: | |

|Mailing Address: | |

|E-Mail Address: | |

|Telephone Number: | |

5.2 Research/research design courses completed by applicant (list by title)

|1. | |

|2. | |

|3. | |

6.0 Research Team Members

List all research team members (including principal investigator) who will have contact with subjects, have contact with subjects’ data, or use subjects’ personal information. NOTE: All research team members must submit a Human Subjects Protection Training Certificate (i.e. CITI Certificate, NIH Certificate, or other).

|Name (First, Middle, Last) |Role in Protocol |

| | |

| | |

7.0 Sponsorship Information

Is your project sponsored by a CCSD Department/Division administrator? □ Yes □ No

If yes:

|Name of sponsor (First, Middle, Last): | |

|Position Title: | |

|Department/Division: | |

8.0 Funding source for this research:

9.0 Compensation for Research Subjects

Will you give subjects gifts, compensation, reimbursement, or services without charge or incentives?

□ Yes □ No

If yes, please explain in detail. NOTE: Compensation for research subjects will be reviewed to ensure compliance with CCSD policies and regulations.

PART B: DESCRIPTION OF THE STUDY

10.0 Define the problem to be investigated in this proposed study. Include relevant background information.

11.0 List the question(s) to be answered or the hypothesis(es) to be tested by the research.

12.0 Describe the research design and methods to be used in the research. Be sure to include a description of the sampling plan and study procedures exactly as they will occur. Design/methods examples: descriptive, formative, phenomenological, ethnographic, qualitative, quantitative, oral history, field work, mixed methods, experimental, quasi-experimental, etc. If a mixed-methods study, provide design/methodology information for each component of the project. When describing the sampling plan, include information about the recruitment/selection of subjects. NOTE: Copies of all recruitment/selection materials must be attached to this application (e.g. advertisements, notices, e-mails, letters, and phone scripts). When describing the study procedures, explain all tasks the subjects will be asked to perform, including the frequency and duration of procedures.

13.0 Describe the data collection methods in detail.

Be sure to address securing permission and making arrangements with principals or administrators who are responsible for the potential subjects of the study. Describe where, how long, and in what format data will be kept. Also indicate what security provisions will be taken to protect the data and ensure confidentiality. NOTE: Copies of surveys, interview questions, focus group questions, and other data collection instruments must be attached to this application.

14.0 Summarize the data collection methods.

Select all that apply.

|Researcher Obtained |

| |Academic tests |

| |Observation |

| |Student records |

| |Psychological intervention/treatment records |

| |Medical records |

|Subject Self-Report |

| |Survey/questionnaire |

| |Interview |

| |Personal interaction with subjects |

15.0 List the sources of data that ARE dependent on school/district records.

Be specific (e.g., academic grades, attendance).

16.0 Indicate the office/school level(s) targeted by the research.

| |District Office | |Region | |Alternative School |

| |Exceptional Students School | |Elementary School | |Middle School |

| |High School | | | | |

17.0 List the site(s) where the research will take place.

A letter of acknowledgement from each site administrator must be submitted with this application.

18.0 Indicate the number of participants and/or subjects in the research.

Use the total column if the grade designation is not applicable.

|Participants |Pre-K |K |1 |2 |3 |4 |

|Students | | | | | | |

|Teachers | | | | | | |

|Principals | | | | | | |

|Parents | | | | | | |

|Other | | | | | | |

20.0 Explain the expected value of research to education in general.

21.0 Explain the expected value of research to CCSD in particular.

PART C: PROTOCOL FOR RESEARCH INVOLVING HUMAN SUBJECTS

22.0 SUBJECTS: Indicate efforts that will be made to assure equitable (gender, ethnicity etc. as appropriate) selection. When vulnerable populations are involved, describe why they are necessary.

23.0 RISKS: Describe any potential risks to the subjects – physical, psychological, social, or legal – and assess the likelihood and seriousness of those risks. If the methods of research create potential risks, describe other methods that were considered and why they will not be used. Describe procedures, including confidentiality standards, for minimizing potential risks.

24.0 BENEFITS: Describe the anticipated benefits of the research to the individual subjects, to the particular group or class from which the subject population is drawn, and/or to society in general.

25.0 RISK-BENEFIT RATIO: Assess the relative weights of the study's risks and benefits.

26.0 COSTS TO SUBJECTS: If the investigation involves the possibility of added expense in time or in money to the subject or to a third party, indicate how this is justified. Be sure this is mentioned in the consent form.

27.0 INFORMED CONSENT: Describe the method of obtaining informed consent, the person(s) who will be responsible for obtaining it, and where the informed consent forms will be stored. When drafting the informed consent form, be sure to include all elements of an informed consent.

NOTE: It is the responsibility of the researcher to retain records relating to the research for at least 3 years after completion of the project.

28.0 CHILD/YOUTH ASSENT: When children are subjects for research, assent from child (Child/Youth Assent Form) and permission from parent (Informed Consent Form) must be obtained. These are two separate documents.

PART D: SIGNATURES

Please obtain all appropriate signatures below.

|Applicant (Print): | | | |

|Applicant (Signature): | |Date: | |

|Faculty Advisor (Print): | | | |

|Faculty Advisor (Signature): | |Date: | |

| |

|CCSD Sponsor: |

|Sponsored research is research that is considered desirable or of special interest to a CCSD division, department, or school. If you are |

|officially sponsoring a research application, your responsibility would be to review the application "to ensure that (1) the proposed research|

|serves an educational purpose and (2) the benefits of conducting the research justify the costs." You would also be responsible for |

|monitoring the project as it is conducted at any CCSD site, but not to the extent of acting as advisor to the project or applicant. |

| |

|Please consider the following questions as you review this application. Record your judgments in the appropriate box beside the question. If|

|a criterion is not met, please indicate what will be necessary for the criterion to be met in the space provided. |

| |

|Question |

|Meets Criterion |

|Does Not Meet Criterion |

|Comment, if no |

| |

|Is this project relevant to the mission of the CCSD? |

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|Is the intrusiveness of the research outweighed by its potential benefit to the District? |

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|Are the research activities compatible with the public school setting? |

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|CCSD Sponsor (Print): | | | |

| | |Date: | |

| | | | |

|CCSD Sponsor (Signature): | | | |

CLARK COUNTY SCHOOL DISTRICT

RESEARCH APPLICATION

APPLICANT PROTOCOL CHECKLIST

( Please use this list to verify that you completed all required steps in preparing your CCSD Research Application. Incomplete applications will not be accepted and will be returned to the applicant.

( Application submitted at least 60 days in advance of research commencement *

( The Applicant/Principal Investigator is:

• Student – when master’s or doctoral and first-hand involvement

• Faculty – when academic research first-hand involvement

( Cover letter included with application

( CCSD Research Application: Sections A, B, C fully completed *

( Human Subjects Protection Training Certificate of Completion *

( CCSD Letter of Acknowledgement – School access investigated *

( University Institutional Review Board

• Approval Letter *

( Copies of instruments (e.g., Consents/Assents with university IRB stamped approval indicia, surveys, interview protocol and/or text, observation protocol)

( Signature(s):

• Applicant *

• Faculty Advisor, if applicable *

• Sponsor, if applicable

For additional details and information, please contact:

Cheryl King, Administrative Clerk

Research and School Improvement

Clark County School District

4260 Eucalyptus Avenue, Annex C

Las Vegas, Nevada 89121-5207

(702) 855-7783 ext. 5270

Alternate: (702) 799-5195

Fax: (702) 799-0292

* Required with CCSD Research Application

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[1] Applicants using human subjects in their research must present an “Assurance Training Certificate.” This may be obtained by completing the on-line course provided by the United States Department of Health and Human Services at the following web site:

United States Department of Health and Human Services: National Institutes of Health (NIH),

Some universities also provide their students and faculty with research ethics education through the Collaborative Institutional Training Initiative (CITI). A CITI certificate is also acceptable.

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