Wisconsin department of public instruction attn: rodney packard pupil data policy advisor




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Wisconsin Department of Public Instruction

LDS DATA ACCESS REQUEST
DISTRICT ADMINISTRATOR AUTHORIZATION FORM

PI-1274-LDS (New 11-09)



INSTRUCTIONS: Complete and submit to:

WISCONSIN DEPARTMENT OF PUBLIC INSTRUCTION

ATTN: RODNEY PACKARD

PUPIL DATA POLICY ADVISOR

BUREAU FOR INFORMATION TECHNOLOGY

P.O. BOX 7841

MADISON, WI 53707-7841

Email at: ldshelp@dpi.wi.gov






I. DISTRICT ADMINISTRATOR LDS DATA ACCESS AUTHORIZATION




Protecting student privacy and maintaining the confidentiality of educational records are the responsibility of all state, district and school personnel. Educational records are protected by state law, sec. 118.125, 118.126, 118.127 and 118.128, Wis. Statutes and federal law, 20 USC 1232 (g) and 34 CFR 99 (FERPA). The Longitudinal Data System (LDS) enables authorized users to have access to confidential information about students. These data are to be used in a manner consistent with the administrative, informational, instructional, and research objectives of the school district and Department of Public Instruction (DPI). Data made available to authorized LDS users may include student level, personally identifiable and sensitive data including but not limited to:

  • Homeless Status

  • Test Results (WSAS, AP, ACT, ACCESS)

  • Incidents of Discipline (suspension, expulsion)

  • Migrant Status

As the district administrator, I understand that I am responsible for, and could be held accountable for, misuse of this data by the users who have access within my district whether the access has been assigned by me or my designee. I agree to authorize access to users of the department’s Longitudinal Data System (LDS) within my district, or delegate administration of this task, in accordance with the statements below.

  • I will respect and safeguard the privacy of students and the confidentiality of student data.

  • I will comply with state and federal privacy laws established to maintain the confidentiality of student data.

  • I will not disclose or transmit confidential student data to persons not specifically authorized to access the data.

  • I understand that my password is as important as my signature. It is my obligation to keep my password confidential. I will not share my password with anyone.

  • I will not use the login and password of others.

  • I will only authorize access to the LDS to licensed educators in the school district or a school district official who has been determined by the school board to have a legitimate educational interest in the data.

  • I understand that the specific role granted to my district users will be based on their legitimate educational need to see the data and utilize the specific functionality made available.

  • I will ensure that district regulations, policies, and procedures are in place to govern authorized access to pupil data and comply with the state and federal laws related to pupil record confidentiality

  • I understand that any user who violates the district’s policies and procedures, any state or federal law related to pupil record confidentiality or the terms of the user agreement, will be denied access to the LDS and could result in denial for all authorized users at the district.

  • I have viewed the privacy training presentation and understand my obligation to protect the confidentiality of the student data that I will be accessing.

  • I will ensure the delegated administrators assigned to authorize access comply with all statements above and have viewed the privacy training presentation.




II. GENERAL INFORMATION




Name of School District Administrator Print or Type

     


School District

     


Work Address Street, City, State, ZIP

     


Wisconsin User ID / WAMS ID

     


E-Mail Address

     


Telephone Area/No.

     





III. SIGNATURE




I HEREBY VERIFY that I have read and understand this authorization form and represent the school district identified herein.

District Administrator Signature

     



Date Signed Mo./Day/Yr.

     


Protecting Student Privacy in Wisconsin: http://www.dpi.wi.gov/lbstat/dataprivacy.html


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