Request for use of friess lake school district




Yüklə 18.26 Kb.
tarix14.04.2016
ölçüsü18.26 Kb.
894-Ex. A
Friess Lake School District

1750 Highway 164

Hubertus, WI 53033
REQUEST FOR USE OF FRIESS LAKE SCHOOL DISTRICT

IN CONNECTION WITH RESEARCH OR SURVEY PROJECTS

BY A GRADUATE STUDENT, UNDERGRADUATE STUDENT, OR FACULTY MEMBER
(Attach abstract of study and any instruments to be administered. Submit in triplicate. Two signed copies are to be returned by the applicant to the appropriate university/college administrative official/dean.)
This routing form is to be used by a college or university faculty member or student desiring to make use of the Friess Lake School District staff, students, facilities, records, etc. in connection with course requirements or research. A faculty member must sponsor use of public schools by undergraduates.


  • Name of College/University





  • (1) Initiator(s) conducting research or survey

Indicate: Undergraduate Student Graduate Student Faculty Member

If undergraduate, indicate faculty member as sponsor:


Contact Info: Phone


  • (2) Initiator(s) conducting research or survey

Indicate: Undergraduate Student Graduate Student Faculty Member

If undergraduate, indicate faculty member as sponsor:


Contact Info: Phone




  • Name of person(s) conducting actual research/survey




  • Location of research or survey project (where will the project be conducted?)


  • Date the project will begin: Date the project will end:






  • Names of students or student groups involved, if any: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


In the abstract of study, specifically address the following:


  1. Indicate that no change will be involved in Friess Lake Board of Education curriculum scope and sequence in any grade or class as a result of the project.



  1. Provide evidence that no control group shall be denied the use of the best teaching methods in use in the school district.



  1. Provide evidence to indicate that the class time devoted to the experimental procedures shall not interfere with the regular allotment of time for the program of studies.



  1. Indicate what procedures will be used regarding obtaining signed releases from the parents of each pupil involved if taping or recording pupils (see Board of Education policy, rule, and exhibit 364.1) ; interviewing pupils; gathering personal information; testing pupils; or administering pupil/parent surveys. These releases are required to be on file in the office of the school administrator.

Signed

(1) Initiator Date



(Signature)

Typed or printed name


Indicate: Undergraduate Student Graduate Student  Faculty Member

(2) Initiator Date



(Signature)

Typed or printed name


Indicate: Undergraduate Student Graduate Student  Faculty Member
APPROVAL

Faculty Member

Sponsor(s) of survey Date

or research project (signature)



[if undergrad]

Typed or printed name


Date (signature)

Typed or printed name


Graduate Student's Advisor Date

(Signature)

Typed or printed name

College/University

Administrative Dean/Designee Date



(Signature)

Typed or printed name


Friess Lake School District Approved Disapproved
District Administrator Date

(signature)

Typed or printed name


894-Exhibit A 11/25/02


Verilənlər bazası müəlliflik hüququ ilə müdafiə olunur ©azrefs.org 2016
rəhbərliyinə müraciət

    Ana səhifə