Statistical Standards Program

Page 1 of 5   =  Required Fields

Principal Project Officer (PPO)

Name

    
First Last

Title

Organization

Address

    
Address (P.O. Box Not Accepted)
 
    
Building Name
 
    
Room # City
 
 - 
State Zip Code

Phone

      ext.  

Fax

        

E-Mail Address

Page 2 of 5   =  Required Fields

Senior Official (SO)

Name

    
First Last

Title

Organization

Address

    
Address (P.O. Box Not Accepted)
 
    
Building Name
 
    
Room # City
 
 - 
State Zip Code

Phone

      ext.  

Fax

        

E-Mail Address

Page 3 of 5   =  Required Fields

Systems Security Officer (SSO)

Check this box if the PPO will also serve as the SSO.

Name

    
First Last

Title

Organization

Address

    
Address (P.O. Box Not Accepted)
 
    
Building Name
 
    
Room # City
 
 - 
State Zip Code

Phone

      ext.  

Fax

        

E-Mail Address

Page 4 of 5   =  Required Fields
1. Below is a categorized menu of surveys. Expand any desired categories by clicking on the "+" sign. Select any surveys you wish to access by checking the associated checkbox. If you don't see the category for which you are looking, look under "Individual Surveys", which is already expanded at the bottom of the list.
Surveys:

1a. You have selected a survey that is protected under FERPA laws and is only available under one of the following exceptions. If your proposed research is for or on behalf of a specific school, educational institution or school district, please identify that entity by name in the research description and request the “Studies” exception below. Otherwise, the “Audit and Evaluation” exception should be selected. Please select the applicable exception below:
Studies:
Licensee will use the subject data only to conduct a study for, or on behalf of,
educational agencies or institutions to improve instruction and as specified in your
description of your research objective and how you will use the requested data; or

Audit and Evaluation:
Licensee will use the subject data only for the purpose of evaluating a Federally
-supported education program and as specified in your description of your research
objective and how you will use the requested data.
2. What is your Project Title?
3. Briefly describe your research objective and how you will use the requested data.
In addition, briefly describe how your proposed research objective falls under the exception to FERPA privacy laws selected in question #1a above.
4. Explain why the public-use files and/or the Data Analysis System (DAS) cannot meet your
research need.
5. If you plan to link the requested data to any other data, list these other dataset names and describe how linking the data will allow you to achieve your research objectives.
6. Which sector(s) of the education community will be served by your work?
7. Do you agree that the requested data will not be used for any administrative or regulatory purpose?
8. How long will you need access to this data?
Page 5 of 5   =  Required Fields
10. List the names and titles and emails of the proposed users of the requested data. You are limited to seven users, including the PPO.

There are currently no proposed users for this License Request. Please add one below.

Note: Access to the secure project office and data is limited to only those persons who are listed above. Each person listed above is required to have a signed and notarized Affidavit of Nondisclosure on file with IES.
Confirmation

There are currently no proposed users for this License Request.

You are about to submit the following information:
 

Principal Project Officer(PPO)

Name:  
Title:
Organization:
Address:
Building:
Room:
City:
State:
Zip:  
Phone:    
Fax:   
Email:

Senior Official(SO)

Name:  
Title:
Organization:
Address:
Building:
Room:
City:
State:
Zip:  
Phone:    
Fax:   
Email:

Systems Security Officer(SSO)

Name:  
Title:
Organization:
Address:
Building:
Room:
City:
State:
Zip:  
Phone:    
Fax:   
Email:
License Type:
Data File Access Needed:
FERPA Exception:
Project Title:
Research Objective:
Public Data:
Data Link:
Education Community:
Agreement Acceptance:
Time Frame:
 
Page 1 of 1   =  Required Fields

Modify Security Plan

1. Describe the proposed modification to the previously submitted security plan.
2. Fill out and send in the mail a new Security Plan form. Do not move the data or implement any of your proposed modifications until you receive an email stating that IES has received your new Security Plan form and that IES has approved it.