Name of applicant by 15ZP20


									Application to Conduct Research in Oakland Unified School District

Thank you for your interest in conducting research at Oakland Unified School District. The guidelines
included in the application are to encourage research in OUSD while respecting the time and privacy of
students and staff. The Department of Research and Assessment (RAD) conducts and supports research that
contributes to a greater understanding of highly effective teachers, instructional strategies, and resources and
conditions that promote academic achievement for all children. All external research applications will be
reviewed by the Research Review Committee from RAD. The role of the Research Review Committee is to
ensure that all proposed research are beneficial to the school district and comply with the ethical codes of
research in addition to state and federal laws. The review process will take up to six weeks to complete
from the date that your application is received.

NOTE: An approval from the Research Review Committee serves only as an authorization to contact the
principal(s) of the school(s) of interest. Researchers will need to secure a separate approval from the
principal(s) before any research work is permitted at school sites.

Part I of this application is required for every request for research or data.
Please follow these steps:

Step 1. Send electronic copies of Part I, II, and your full research proposal to the Coordinator of Research.
         If the application includes only a research request without additional district data request, skip
          Steps 2 and 3. The Coordinator of Research will contact you regarding the research approval

         If your research includes a student-, school-, or district-level data request, you will be contacted by
          the Coordinator for Data Support who will provide consultation on your data needs and cost
          estimates for data retrieval.

Step 2. When data requests are approved and cost estimates are agreed upon, you will be required to sign
        and submit Part III (“Agreement with the Oakland Unified School District for Grant Administration
        Related Services”) to the Grants Office.

Step 3. After the data agreement has been approved and signed by the OUSD Chief Financial Officer, the
        requested data will be transferred to you. After this data transfer is completed, payment will be due
        within 14 days.

REQUIRED ATTACHMENTS (Your application will NOT be reviewed if items are missing)
1.  Competed and signed copy of OUSD Application to Conduct Research
2.  Electronic copy of your full research proposal, all research instruments and
    corresponding consent forms
3.  Letter of support from faculty advisor (students only)
4.  A copy of your human subjects committee (or IRB/CPHS) approval.

       Please e-mail, mail, or fax the signed documents to: Anne Okahara, Research Coordinator,
           Research, Assessment & Data, 1011 Union Street, Annex Bldg., Oakland, CA 94607
        Email: Phone: 510-451-4164 Ext. 1101 Fax: 510-451-1814

                                                           OUSD ApplicationForResearch.doc (rev. 11/3/2012)   1 of 10

Name of Researcher(s):                                                                       Date:
Address 1:
Address 2:                                    City:                                 State:                Zip:
Phone:                                      Email:

Are you an Oakland Unified School District employee?          Yes       No
    If YES, which school or department:
    If NO, which company or university?

Which higher degree do you now have?          B.A./B.S.     Masters          Doctorate         Other        None
Is this study part of your master’s thesis or doctoral dissertation?      Yes        No
Faculty Advisor Name:                                                           Advisor Phone #:
Advisor Email:

Title of Research Study:

1. Purpose of study. Summarize the background and rationale for your study. Highlight your
   research questions.

2. Study Procedures. Describe how the research will be conducted, providing information about all
   study procedures (e.g., interventions/interactions with participants, observations, sampling, and instruments).

3. Describe any potential benefits of your study to Oakland public schools.

4. Describe any potential risks to the participants in your study.

5. What is your plan for sharing and disseminating the findings from your study?

6. Study Sample: Identify the group, number, and grade levels of participants who will be                        directly
   involved in your study.
   # of schools:                   Grade(s): K 1 2 3 4 5 6 7 8 9 10                                              11   12
   # of teachers:                  Grade(s): K 1 2 3 4 5 6 7 8 9 10                                              11   12
   # of students:                  Grade(s): K 1 2 3 4 5 6 7 8 9 10                                              11   12
   # of school administrators:     Number of parents:
   # of Others:

                                                              OUSD ApplicationForResearch.doc (rev. 11/3/2012)             2 of 10
7. Special characteristics of subjects

8. Time requirements of study
    a. Total in-school individual pupil time involved, if any:
       Length of each session:                   Number of sessions:                      Spacing of sessions:
    b. Total in-school teacher and administrator time involved, if any
       Length of each session:                   Number of sessions:                      Spacing of sessions:
    c. Will non-school time be involved?         If so, how much?                         When?

9. Data needed from school or district records
Please complete Part II & III: “Request For OUSD Student Level Data” form.

10. If others besides staff members or pupils are to be directly involved, describe the nature of the
   involvement and the amount of time required.

11. Projected start date:                             Projected Completion Date:
                                                      (Contact OUSD if your research exceeds the projected completion date)

12. Are specific schools being requested?
    If so, which ones?

13. Have you already contacted the principals of those schools?          Yes         No

14. Date that a report of the research study will be provided to the Oakland Unified School District:

The proposed research activities to be conducted within Oakland Unified School District are in compliance
with existing legal and ethical codes. The research will not differ significantly from the activities described
within the proposal. All participation will be voluntary, and it is understood that approval of the proposal, if
granted, will not obligate any person, school, or office in OUSD to participate. All student or staff data
provided by the district will not be shared with other researchers or organizations. Any amendments to the
original proposal must be submitted to and approved by the Research Review Committee.

All researchers agree to provide the office of Research, Assessment & Data and each participating
school with a copy of the research findings. Failure to do so will directly affect your company or
university’s future access to the district.

I understand and agree with the above statement, and will follow the guidelines it sets forth. I have read and
accept the provisions of Bulletin 4050, titled “Research Requests.”

Please sign and mail or fax this signature page to the Research Review Committee.

Signature of principal investigator/researcher                       Date

                                                             OUSD ApplicationForResearch.doc (rev. 11/3/2012)        3 of 10
Grant’s Fiscal Agent Name:

Fiscal Agent Address

Fiscal Agent Phone                                               Fiscal Agent Email
                                                                        Grant Amount for Full
Funding Cycle Dates:                                                    Funding Cycle:

Funding Agency:                                                          Grant Focus:

Are you an evaluator contracted by OUSD?                                                                                    Yes   No

Are services being supported by an OUSD funded grant or by a contractor paid through                                        Yes   No
an OUSD contract or MOU?
(If yes, include the district’s indirect rate of 6.49% for all OUSD site services in the grant’s budget for
administrative support, evaluation data, or indirect services.)

1. Include a brief timeline for your data request.

2. Potential List of Data Elements Requested (Please select all of the data elements needed.)
Demographics                                       Special Programs
   Gender                                            Gifted and Talented (GATE)
   Ethnicity                                       Academics
   Title 1 Flag                                       Courses Taken
   Special Education                                  Course grades
   School                                             Current year GPA
   Grade Level                                        Cumulative GPA
   Days Suspended                                     GPA in certain Courses
   Number of Times Suspended                          California Standards Test Results (CST)
   Attendance (Days Absent/Enrolled)                  High School Exit Exam (CAHSEE)
   Primary Language Spoken                            Local Benchmark Assessment Results
   Language Proficiency                               CELDT Test Results
   OTHER: (Please describe in Section 3 below.)       Retention
Customized data design and technical support are provided at 1% of the grant award or at a negotiated fee for a community-based fiscal
agent who is not including OUSD’s indirect rate of 6.49% in the budget. The 1% or negotiated data fee will be charged according to an
Agreement for Grant Administration Related Services payment schedule. This fee should be included in the grant’s budget for

3. Describe additional data elements that are not listed in Section 2 above.

                                                                              OUSD ApplicationForResearch.doc (rev. 11/3/2012)    4 of 10
4. Select the desired file format of the data you have requested above:
     Excel     Access      Comma delimited       Tab delimited         Text files      Other:

For questions with data requests, contact: Kevin Smith, Data Support Coordinator Phone: 510-451-4164 Ext.1101 Fax: 510-451-1814


Step 1. Send Part I & II to the Research Coordinator.
        If the application includes only a research request without data needs, the Research Coordinator will
        contact you regarding the research approval process.

        If the research includes a student-, school-, or district-level data request, you will be contacted by the
        Data Support Coordinator who will provide consultation on your data needs and cost estimates for
        data retrieval.

Step 2. When data requests are approved and cost estimates are agreed upon, you will be required to sign
        and submit Part III (“Agreement with the Oakland Unified School District for Grant Administration
        Related Services”) to the Grants Office.

Step 3. After the data agreement has been approved and signed by the OUSD Chief Financial Officer, the
        requested data will be transferred to you. After this data transfer is completed, payment will be due
        within 14 days.

Please read and sign below.

I,                                                         , the principal investigator, agree to the following:

 I understand that the release of the confidential student data provided by Oakland Unified School District is
  prohibited under the EDUCATION CODE, Section 60650.
 All student data provided by the district will not be shared with other researchers, third party organizations
  and will be used solely for the purposes stated in this initial request for data.
 I will follow all District protocols for acquiring and using district data.
 I will not solicit data from other departments or school sites within OUSD.
 I understand that I may have to pay a fee for the collection, organization, visualization, and dissemination of
  student data based on budget rules established by OUSD.
 OUSD reserves the right to review a draft report before finalizing the report and releasing it publicly.
 Pending approval of my data request, I will be required to sign a contract that will formally describe each of
  the key OUSD requirements for access and use of District data.
 I acknowledge that I fully understand that the intentional release by me of this information to any
  unauthorized person could subject me to penalties imposed by law.

Signature of principal investigator                                  Date

Office Use Only
This request has been reviewed and approved by                                           , the Data Support

Date of consultation:                                      Cost estimate: $

Signature                                                  Date
                                                             OUSD ApplicationForResearch.doc (rev. 11/3/2012)   5 of 10
PART III. Agreement with the Oakland Unified School District for Grant
Administration Related Services.
This AGREEMENT is made as of the              th day of        , 2012, by and between the Oakland Unified School District
(“DISTRICT”) and    (“AGENCY").


WHEREAS, the DISTRICT has observed that public and non-profit agencies providing services to the District through
grant funding spend thousands of dollars annually for private firms to gather and analyze non-confidential or specifically
authorized confidential student data that the District has access to and has the capacity to analyze; and

WHEREAS, the DISTRICT is not required by statute to gather and analyze non-confidential or specifically authorized
confidential student data to assist public and non-profit agencies working for the enrichment of District students though
grant funding; however, the District can perform this service in a cost effective manner and desires to provide this service
in order to reduce the administrative cost to grant programs benefiting the District’s students; thereby conserving monies
available through such programs; and

WHEREAS, such service may be provided for a fee to offset the cost to the District for rendering such service.

NOW, THEREFORE, the parties agree as follows:

1.    RENDITION OF SERVICES: The DISTRICT agrees to provide the services identified below in
      accordance with the terms and conditions of this Agreement.

2.    SCOPE OF SERVICES: The scope of the DISTRICT’S services shall consist of the services set forth in
      Exhibit A, and as may be amended from time to time by the parties, in writing.

3.    SCHEDULE AND TIME OF COMPLETION: The term of this Agreement shall commence on                ,
      2012 and shall terminate on , 2013, unless terminated sooner pursuant to Section 12, of this

4.    RESPONSIBILITY/INDEMNIFICATION: DISTRICT’s exposure to liability with respect to this agreement
      shall be limited to the contract compensation amount.

5.    AGENCY’S USE OF DISTRICT INFORMATION: AGENCY agrees that the information provided by
      DISTRICT shall be used for program evaluation and reporting requirements for grants benefiting
      DISTRICT students and such information will not be used for commercial purposes or uses that may be
      inappropriate as determined by the DISTRICT. In the event that DISTRICT, in its sole discretion, at any
      time during the term of this agreement, deems AGENCY’s use of the information provided by the
      DISTRICT to be inappropriate or not in keeping with the terms of this agreement, the DISTRICT may
      immediately cancel the agreement and require AGENCY to immediately return and cease use of the
      With respect to confidential student data, by signing this agreement, AGENCY and its duly authorized signatory
      certify under penalty of perjury of the laws of the State of California that AGENCY is specifically and duly authorized
      to view and receive the information provided by the DISTRICT pursuant to this agreement.

COMPENSATION: AGENCY agrees to pay DISTRICT the sum of $                  (e.g. 1% of annual grant allocation) for
   performance of the services identified in Section 2 of this agreement and Exhibit A hereto.

 6.   MANNER OF PAYMENT: DISTRICT shall submit invoice(s) for the services performed under this Agreement. Said
      invoice(s) shall describe the work performed and the name of the person(s) performing those services. DISTRICT’s
      invoice(s) must be paid within thirty (30) days of submission of invoice, except for such portion of the invoice, which
      may be the subject of dispute.

                                                                  OUSD ApplicationForResearch.doc (rev. 11/3/2012)     6 of 10
7.      DISTRICT’S STATUS: Neither the AGENCY nor any party contracting with the AGENCY shall be
        deemed to be an agent or employee of the DISTRICT.

8.      ASSIGNMENT: AGENCY shall not assign any of its rights nor transfer any of its obligations under this
        Agreement without the prior written consent of DISTRICT.

9.      DISTRICT WARRANTIES: The DISTRICT makes no warranties, representations or agreements, either
        express or implied, beyond such as are explicitly stated in this Agreement.
DISTRICT REPRESENTATIVE: Except when approval or other action is required to be given or taken by the Board of
    Directors of the DISTRICT, the Superintendent of the DISTRICT, or such person as he or she shall designate, shall
    represent and act for the DISTRICT.

10. SUSPENSION AND TERMINATION: The DISTRICT and AGENCY shall have the right to suspend or to
    terminate this Agreement at any time by giving the other party thirty (30) days written notice

11. KEY PERSONNEL: It is understood and agreed by the parties that at all times during the term of this
    Agreement, Valerie Williams, shall serve as the primary staff person of DISTRICT to undertake, render
    and oversee all of the services under this Agreement.

12. NOTICES: All communications relating to the day-to-day activities of the project shall be exchanged
    between the designated DISTRICT representative(s) and the AGENCY.
        All other notices and communications deemed by either party to be necessary or desirable to be given to the other
        party shall be in writing and may be given by personal delivery to a representative of the parties or by mailing the
        same postage prepaid, addressed as follows:

                                   Grants Office
                                   1025 2 Avenue, Room 112
                                   Oakland, California 94606
                                   ATTENTION: Valerie Williams, Grants Coordinator

                                  If to the AGENCY:


        The address to which mailings may be made may be changed from time to time by notice mailed as described
        above. Any notice given by mail shall be deemed given on the day after that on which it is deposited in the United
        States Mail as provided above.

13. ATTORNEYS' FEES: If any legal proceeding should be instituted by either of the parties hereto to
    enforce the terms of this Agreement or to determine the rights of the parties thereunder, the prevailing
    party in said proceeding shall recover, in addition to all court costs, reasonable attorneys' fees.

14. APPLICABLE: This Agreement, its interpretation and all work performed thereunder, shall be governed
    by the laws of the State of California.
        All of the terms, provisions and conditions of this Agreement shall be binding upon and inure to the benefit of the
        parties hereto and their respective successors, assigns and legal representatives.

IN WITNESS WHEREOF, the parties hereto have executed this Agreement by their duly authorized officers as of the day
and year first above written.


By:                                                                        Date:
      Title: Fiscal Officer

By:                                                                        Date:
                                                                   OUSD ApplicationForResearch.doc (rev. 11/3/2012)   7 of 10
                                                         EDUCATION CODE, Section 60650:
No test, questionnaire, survey, or examination containing any questions about the pupil’s personal beliefs or practices in sex, family life, morality and
religion, or any questions about his parents’ or guardians’ beliefs and practices in sex, family life, morality and religion, shall be administered to any
pupil in kindergarten or grade 1 through grade 12, inclusive, unless the parent or guardian of the pupil is notified in writing that such test,
questionnaire, survey, or examination is to be administered and the parent and guardian of the pupil gives written permission for the pupil to take
such test, questionnaire, survey, or examination.

PUBLIC LAW 103-227 – MARCH 31, 1994
108 STAT.268

SEC. 1017. PROTECTION OF PUPILS. Section 439 of the General Education Provisions Act (20 U.S.C. 1232g) is amended to read as follows:

   “SEC 439. (a) All instructional materials, including teacher’s manuals, films, tapes, or other supplementary material which will be used in
      connection with any survey, analysis, or evaluation as part of any applicable program shall be available for inspection by the parents or
      guardians of the children.

    “(b) No student shall be required, as part of any applicable program, to submit to a survey, analysis, or evaluation that reveals information
         “(1) political affiliations;
         “(2) mental and psychological problems potentially embarrassing to the students or his family;
         “(3) sex behavior and attitudes;
         “(4) illegal, anti-social, self-incriminating and demanding behavior;
         “(5) critical appraisals of other individuals with whom respondents have close family relationships;
         “(6) legally recognized privileged or analogous relationships, such as those of lawyers, physicians, and ministers; or
         “(7) income (other than that required by law to determine eligibility for participation inn a program or for receiving financial assistance under
            such program), without the prior consent of the student (if the student is an adult or emancipated minor), or in the case of an
            unemancipated minor, without prior written consent of the parent.
    “(c) Educational agencies and institutions shall give parents and students effective notice of their rights under this section.
    “(d) ENFORCEMENT—The Secretary shall take such action as the Secretary determines appropriate to enforce this section, except that action
         to terminate assistance provided under an applicable program shall be taken only if the Secretary determines that—
                 “(1) there has been a failure to comply with such section; and
                 “(2) compliance with such section cannot be secured by voluntary means.
    “(e) OFFICE AND REVIEW BOARD—The secretary shall establish or designate an office and review board within the Department of Education
         to investigate, process, review, and adjudicate violations of the rights established under this section.”

March, 1978


POLICY. The Oakland Public Schools recognize a responsibility to participate in educational research activities and to assist in the growth of
graduate students. Because of the value of research to the field of education and because of the need for educators to be trained in research
methods, the Oakland Public Schools shall support and encourage educational research in the district when the conduct of such projects is feasible,
offers potential benefit to the educational program of the district, and does not conflict with the major functions of the schools.

RESEARCH STUDY SOURCES. Research requests from the following sources will be recognized:
   Members of the local District staff.
   University of college-sponsored staff members.
   Doctoral or Master’s Degree candidates from within or without the District.
   Local, state, and national professional organizations or firms.
   Local Oakland community organization.

In general a study request submitted by an individual who is not a member of the staff of the Oakland Public Schools to fulfill the requirements for a
specific college course or class will not be approved. Undergraduate research studies will not, in general, be encouraged or approved.

                                                                                  OUSD ApplicationForResearch.doc (rev. 11/3/2012)                  8 of 10
PROCEDURES. The following procedures pertaining to research study requests shall apply:

Studies requiring principal’s approval only. If a research project proposed by a district staff member is to be limited to the school in which the
staff member is employed, the study may be authorized by the building principal and reported to the appropriate Area or Associate Superintendent
and to the Director of Research and Evaluation to determine the appropriate course of action.

Studies requiring advance approval by Superintendent. All research projects which involve two or more schools, or which requires access to
District office records, or which have public relations implications, or which involve considerable interruption of regular class instruction must be
approved by the Superintendent in advance. Application for conducting such studies must be made to the Director of Research and Evaluation on
the district form available in the Department of Research and Evaluation. Members of the District staff as well as persons from outside the District
shall observe this regulation. If a principal has questions regarding whether an inquiry from staff or non-staff personnel should be treated as a
research study, the principal shall contact the Director of Research and Evaluation to determine the appropriate course of action.

Upon receipt of such an application, the Director of Research and Evaluation shall ascertain the value, the feasibility, and the appropriateness of the
study and when necessary, request the applicant to make necessary modifications. After determining that the study is appropriate, valuable, and
feasible, he or she shall submit that application to a committee composed of the two Area Consultants for Planning, the Director of Research and
Evaluation, and one other certificated staff member from the Department of Research and Evaluation. That committee shall meet four times yearly,
shortly after September 30, November 30, January 31, and June 15 for the purpose of recommending approval or disapproval of those applications,
or to suggest modifications. Those applications which the committee recommends for approval shall be submitted to the appropriate Area or
Associate Superintendent.

Upon receiving approval of the appropriate Area or Associate Superintendent, the Director of Research and Evaluation shall prepare
recommendations to the Associate Superintendent for Support Services who, in turn, shall submit recommendations to the Superintendent.

Such recommendations shall be based upon the conformity of the study proposal to the criteria and procedures specified in this policy and upon
recommendations made by the needs of the affected divisions, and departments, and schools.

Applicant’s responsibilities. It is the responsibility of the applicant to obtain a copy of the district Administrative Bulletin No. 4050 and three copies
of the application from (see page 4). The applicant also evaluates his or her proposal according to the aforementioned policies and procedures and
obtains the approval of his or her advisor. It is expected that the applicant will be able to utilize records and reports with minimum use of the time of
Oakland Public Schools employees.

If a study is approved, a copy of the research findings must be provided to the Oakland Public Schools Research Department at the conclusion of
the project.

It shall be assumed that any questionnaire or inquiry coming to District staff members by U.S. mail does not have district approval unless
authorization has been given by the Superintendent.

District administrative research studies. Administrative research studies conducted by District or area offices do not require application to the
Department of Research and Evaluation. However, the assistance of the Department of Research and Evaluation may be requested as needed.

CRITERIA FOR JUDGING STUDY REQUESTS. Any and all requests, from whatever source must satisfy the following criteria:

Value. The study to be undertaken must have some potential value to the education generally and to the Oakland Unified School District

Design. The design of the study must be technically sound and adequate to reach the desired ends. Applications from candidates for degrees shall
be accompanied by a copy of a written approval from the major advisor or dean of the college or university involved.

Minimal interruption. The collection of data and the nature of the research must not significantly interfere with the normal instructional program.
The extent of interruption must be weighed against the anticipated value of the findings.

Privacy. The nature of the data and the method of the collection must not invade the privacy of students, parents, or teachers. Names of pupils or
schools must not be identified in university classes, written papers, professional journals, newspapers, or in private contracts by the person doing the
research. Inquiries as to financial status, marital status, ethnic or religious status, and other such personal information are prohibited. (Ed. Code

                                                                                  OUSD ApplicationForResearch.doc (rev. 11/3/2012)                 9 of 10

No pupil may be identified by name when information from records, tests, surveys, questionnaires, and the like is submitted for research.

Parental permission. If any students are to be tested individually or if any groups of students are to be given any test or instrument designed to
measure sociological or personally characteristics, written permission of the parent or guardian must be obtained prior to any such testing.

Public relations. The possibility of negative public relations must be given consideration.

Copies of instruments. Copies of all questionnaires, tests, or other instruments must accompany the request to conduct the research project
unless such instruments are well-known standardized tests. Any and all instruments used in a research project must have been approved by the
Senior Researcher even though the general research project might have received earlier approval. Any revisions or changes in approved
instruments must also be submitted for approval.

INFORMATION. Questions concerning these procedures may be directed to the Senior Researcher in the Department of Research, Assessment,
and Accountability.

Approved by Board on March 22, 1978

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