1 NC Department f Public Instructin Research Data Request Frm The fllwing frm may be used t request student data frm the Nrth Carlina Department f Public Instructin (NCDPI). Please understand that the DPI data s primary purpse is t supprt required state and federal reprting, funding f lcal educatin agencies, educatin accuntability, and public reprting. Data requests utside this scpe can nly be accmmdated as resurces are available. 1 If a data request is apprved, it will be filled based upn a DPI pririty list that may nt be in accrd with the requester s timeline. Criteria used t determine apprval r denial f research data requests NCDPI will cnsider research requests fr student and staff-level data frm graduate students (Master s r PhD level) r prfessinal researchers, and fr which there is an agency spnsr. NC DPI recmmends that individual student and/r staff recrd data requests g t the Nrth Carlina Educatin Research Data Center, with whm we partner t supply recrd level data (http://www.childandfamilyplicy.duke.edu/prject_detail.php?id=35). Graduate Students must have a letter f supprt frm their supervising prfessr, and the university must have an Institutinal Review Bard (IRB). Unslicited research prpsals frm individuals r rganizatins independent f NCDPI must be affiliated with an IRB if requesting student-level data r prvide a letter f supprt frm the spnsring prfessr, rganizatin r Federal gvernment. If the request is apprved, NCDPI will nly grant access t student level data that are directly relevant t the request. Please return the cmpleted and signed frm t: NC Department f Public Instructin 6367 Mail Service Center Raleigh, NC 27699 Attn: KC Elander, Educatin and Plicy Cnsultant 1 Please see the Nrth Carlina Public Recrds Act at www.ncga.state.nc.us fr mre infrmatin.
2 All requests fr Persnally Identifiable Infrmatin (PII) (student-level data) must be apprved by the State Superintendent r designee. The NC DPI staff will seek apprval n behalf f all data requestrs. If the data request is apprved fr PII abut individuals, all requesters must adhere t the fllwing requirements: Requester must be respnsible fr the infrmatin btained fr using it apprpriately, and nly fr authrized purpses. Requester must nt use the data fr any ther purpse r research ther than the specific purpse stated in this request. Requester must agree t cmply with the prvisins f the Family Educatin Rights & Privacy Act (FERPA). Cnfidentiality agreements are required fr all persnnel wh have access t the requested data. A cpy f the cnfidentiality agreement fr utside agencies may be btained frm http://www.ncpublicschls.rg/data/management/resurces/. If the requester deliberately r accidentally misuses the btained infrmatin, the requester may lse access t data, and/r face dismissal r prsecutin under the scpe f all applicable federal and state laws. The requester may nt share data and infrmatin prvided by NCDPI with any ther entity withut prir written apprval frm NCDPI. Data frm NCDPI must nt be taken utside the United States. A Memrandum f Agreement (MOA) between NCDPI and any rganizatin r individuals cnducting educatinal research is required fr the release f any PII abut individuals. (DMG-2009-001-RR) Results will nt be displayed r distributed in a breakdwn by student grup where the number f students in the grup is t small (fewer than five). In any grup where the percentage f students is greater than 95% r less than 5%, the actual values may nt be displayed because f federal privacy regulatins (FERPA). (DMG-2009-004-SE) NCDPI reserves the right t bill fr all effrt required t cmplete a data request which invlves custmized prgramming nt already in prductin. Aggregated level data will nt require a MOA/MOE r cnfidentiality agreement.
3 NCDPI Data Request Frm Please cmplete all fields. Prviding this infrmatin will help DPI prcess yur request quickly and accurately. Date f Request: Requester: Title: Phne: Mailing Address: E-mail: Organizatin: Brief Descriptin f Organizatin: Desired Date (Data requests will be filled based upn NCDPI pririty list): Is there smene at NCDPI wh is spnsring yur data request? If yes, prvide the name and title: Descriptin f Data Request: Data Level State LEA (District) Schl *Teacher/Class *Student (The researcher will be referred t NC ERDC and required t enter int a frmal Memrandum f Agreement [MOA]) *This type f request is uncmmn and typically referred t NC ERDC fr cmpletin. If requesting individual (teacher r student) level date, under what exceptin t FERPA des yur research r rganizatin fall? Study Accrediting Organizatin Financial Aid Other:
4 NCDPI Data Request Frm Purpse/Hw Data Will Be Used (The explanatin shuld include the study title, a descriptin f yur research and the questin(s) yu are trying t answer): Target Audience: List All Variables/Data Elements Being Requested Hw Wuld Yu Like T Receive This Data? Electrnic Cpy (Be sure t prvide an email address) Hard Cpy (Please prvide a mailing address) In What Frmat Wuld Yu Like Yur Data? (i.e. Excel spreadsheets) Ptential Benefits t Nrth Carlina Educatin: Additinal Infrmatin:
5 NCDPI Data Request Frm I understand and agree t the terms, cnditins, and respnsibilities set ut in this Agreement. Signature f Requestr Date TO BE COMPLETED BY NCDPI STAFF: NCDPI Authrizatin: Pririty Level: Lw High NCDPI staff respnding t the request: Date and name infrmatin was released: Referred t NC ERDC: