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University Schools Research Project Application

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Project Information

Title of Project

Anticipated Date of Project Implementation

Anticipated Completion Date

Brief Project Description200 words max

Provide a timeline of your proposed research activities

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Principal Investigator Information

Name

Department

Phone Number

Email Address

Classification

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Supervising Faculty Information (for students only)

Faculty Member Name

Department

Phone Number

Email Address

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School Involvement

Select School (Check all that apply)

UofM Early Learning & Research Center

Campus School

University Middle

Other

Is the subject of your research faculty/teachers, staff or students? (check all that apply)

Preferred Number of Students/Faculty/Staff (please specify for each)

Grade Level(s) of Students/Faculty

Types of data you plan to collect (e.g. list specific instruments, assessments, etc. if applicable)

Unique characteristics of requested subjects (ex: race, gender, interest, etc.)

Will the subjects be studied as individuals or in groups?

Will you request access to any data in the student personal records?

If you selected "yes," please list the specific information needed:

Will persons at the school other than students be engaged in your research?

If you selected "yes," please indicate who and how:

List any equipment and materials to be used (these are the responsibility of the researchers)

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If you are proposing to implement a program of any kind, complete the following:

-Program Description

-Time Needed Per Session:

-Number of Sessions

-Total minutes per session

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Is there any other information you wish to share?

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(Note: Approval to conduct research in the University Schools is contingent upon University IRB approval.)

Consent

By initialing to each section below you agree to the following:

I agree to provide one of the following: (1) A briefing to the teachers and staff on the results of the research; (2) A workshop or seminar related to the research results that could help improve instruction; and (3) A final report. The researcher will consult with the principal at the conclusion of the research to determine the feedback format most preferred by the school faculty.

I agree to acknowledge the specific University of Memphis School as the site of this research in publications and/or presentations and provide an electronic copy of published or presented material to the building principals which may be disseminated by the school and/or hosted online.

I understand that my proposed timeline and proposal may need to be altered to coordinate with the needs of the students and faculty of the school. I understand that my role as a researcher must not interfere with or impact the educational mission of the school or the experience of its students. I agree to keep strictly confidential all school student records to which I may have access. I further stipulate that any report of my results will be written so that the individual student data are not identifiable.

I acknowledge that failure to comply with these guidelines may result in the loss of research privileges in the University Schools.

Text Messages (Optional)

I agree to receive text message communications from the University of Memphis

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University Schools Research Project Application