Request Form

Please note: Reflecting state and federal guidelines, MISD cannot freely disclose who receives free and reduced price lunches. To obtain this information, consent forms must explicitly state a researcher’s intent to obtain this information, that the information will be used only for the research indicated and will not be re-disclosed. The signed consent form must also specifically request that MISD provide the lunch status information to the researcher.

Additionally, employees of the District often need access to sensitive information to carry out their jobs, however this access does not grant them permission to use data for reasons other than the specific purposes for which they were granted initial access. Schools and school staff are generally not considered “owners” of data for purposes of determining the appropriateness of its release. A data owner is the administrator, director or supervisor of the division that collects and/or uses data on behalf of the entire District. In other words, just because a teacher has access to testing information does not give them explicit right to use this information without permission.

External Research Request for Access Form

External Research Request for Access Form

 * Date:


 * Name of Applicant:


 * Phone Number:


 * Email Address: 


 * Street Address: 


 * City: 


 * State: 


 * Zip Code: 


 * Title of Project:


 * Name of Direct Supervisor: 




Describe in 700 words or less what your project will address; the procedures you will employ; the expected outcome in terms of your hypotheses, objective and, possible benefits your completed project will have for MISD. This abstract must be a synthesized statement. Please do not simply state “see attached” as most protocols well exceed this limit.

 Enter abstract information here.

 Project staff (Name, role):

 List all project staff, including anyone involved in data collection and/or analysis.

 * Number of students involved:


 * Estimated total time required of students: 


 * Number of teachers involved:


 * Estimated total time required of each teacher (expressed in hours):


 * Number of additional MISD staff involved (may include administrator; clerical, etc.): 


 Will materials from the cumulative records of students or teacher be required?




 If yes, detail materials that will be used.

 * At what grade levels is the project to be conducted?


 At what school(s) will the research be conducted?

 List schools.

 * Anticipated start date: 


 How will subject’s anonymity be protected?

 List details.

 How will parent permission be abtained? or "N/A"

 List details.

 If applicable how will students’ assent/consent be obtained?

 List details.

 IRB/HSRB permission if applicable.


Email all required documents listed below to Beth Nicholas at

Test Forms
Interview Protocols

Security Measure