Application for IRB Review Exemption: Secondary or Pre-existing Data
Name:
Student/Faculty Name:
Email Address:
Thesis/Dissertation? If yes, please specify faculty advisor/dissertation chair name.
Title of Project:
1. Abstract of research project (200 words or less).
2. State the main hypotheses/research questions for the propose project.
3. Please check the box(es) that best describe your research:
Research involving existing documents such as websites, articles, curriculum, textbooks, historical
documents, etc. (e.g. content analysis). Briefly describe documents and how they will be accessed.
(Graduate students only; faculty do not need to complete this form for this type of research)
Research involving the statistical analysis of deidentified data from a database. Specify name of
database:
Is database publicly available?
Yes, give website
No, describe how you have access to the database.
Research involving the statistical analysis of deidentified secondary data (collected by the school or
institution for purposes other than research). Please include letter of permission from all
institutions/schools that are providing the data.
Select type of data:
Standardized Assessment data
Years of data being analyzed
Name of assessment:
Briefly describe the original purpose and administration of the assessment (who, what, where,
when).
Anonymous survey data administered by institution/school
Please briefly describe purpose and administration of survey (who, what, where, when). Include
a copy of the survey or examples of the items.
Institutional/school data
Specify type(s) (e.g. GPA, attendance, discipline referrals, retention rates, etc.)
Please describe data scrubbing and sampling procedures.
Other
Please describe the data as well as the original method and purpose of collection.
4. Indicate the duration and location of secure data storage and the method to be used for final
disposition of the data. Please note: federal regulations require data storage for at least three
years.
a. How long will paper records be stored?
years
b. Where will paper records be stored? (describe secure location)
c. How long will electronic records be stored?
years
d. Where will electronic records be stored? (describe encryption or password protection)
5. Expected date of completion of project (including analysis and write up)