"Approval Form" - Oklahoma

Approval Form is a legal document that was released by the Oklahoma State Department of Education - a government authority operating within Oklahoma.

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Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Oklahoma State Department of Education.

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Download "Approval Form" - Oklahoma

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OFFICE of LEGAL SERVICES
APPROVAL FORM
Request for State Board of Education Approval for Access to Individual Student-Level Data
Oklahoma law, at 70 O.S. § 3-168, defines individual student level-data as confidential and not subject to Open
Records Act requests. In addition, disclosures of student data must comply with provisions of the Family
Educational Rights and Privacy Act of 1974 (FERPA) at 20 U.S.C. § 1232g et seq and accompanying regulations
at 34 C.F.R. Part 99.
I. CONTACT INFORMATION:
Contact Name: _____________________________________________________________________________
Contact Title: ______________________________________________________________________________
Contact Phone No.: _________________________________________________________________________
Contact Email: _____________________________________________________________________________
Name of Agency/ Organization/ Entity: _________________________________________________________
Physical Address (No P.O. Boxes): ______________________________________________________________
Room/Office/Suite No.: _______ City: __________________________ State: ______ Zip: _______________
Type of Agency/Organization/Entity (check all that apply):
☐ For profit organization
☐ Higher education institution
☐ Not for profit organization
☐ Media
☐ Local, state, federal, or tribal government agency
☐ Other (please describe): _________________________________________________________________
II. INFORMATION ABOUT YOUR DATA REQUEST
Please attach a written description of your request which includes an explanation of each one of the following items:
☐ A detailed description of the data you request.
☐ A statement of the purpose of the data request that includes a detailed explanation of how you propose to use
the data requested, including, but not limited to, a description of any project or report for which you intend to
use the data and whether the data or any product derived from the data will be used for commercial purposes.
☐ A detailed explanation of how your proposed use of the data requested will benefit Oklahoma public schools
school districts, public school students and/or their parents/legal guardians, public school teachers and/or
administrators, or the OSDE.
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OFFICE of LEGAL SERVICES | APPROVAL FORM
OFFICE of LEGAL SERVICES
APPROVAL FORM
Request for State Board of Education Approval for Access to Individual Student-Level Data
Oklahoma law, at 70 O.S. § 3-168, defines individual student level-data as confidential and not subject to Open
Records Act requests. In addition, disclosures of student data must comply with provisions of the Family
Educational Rights and Privacy Act of 1974 (FERPA) at 20 U.S.C. § 1232g et seq and accompanying regulations
at 34 C.F.R. Part 99.
I. CONTACT INFORMATION:
Contact Name: _____________________________________________________________________________
Contact Title: ______________________________________________________________________________
Contact Phone No.: _________________________________________________________________________
Contact Email: _____________________________________________________________________________
Name of Agency/ Organization/ Entity: _________________________________________________________
Physical Address (No P.O. Boxes): ______________________________________________________________
Room/Office/Suite No.: _______ City: __________________________ State: ______ Zip: _______________
Type of Agency/Organization/Entity (check all that apply):
☐ For profit organization
☐ Higher education institution
☐ Not for profit organization
☐ Media
☐ Local, state, federal, or tribal government agency
☐ Other (please describe): _________________________________________________________________
II. INFORMATION ABOUT YOUR DATA REQUEST
Please attach a written description of your request which includes an explanation of each one of the following items:
☐ A detailed description of the data you request.
☐ A statement of the purpose of the data request that includes a detailed explanation of how you propose to use
the data requested, including, but not limited to, a description of any project or report for which you intend to
use the data and whether the data or any product derived from the data will be used for commercial purposes.
☐ A detailed explanation of how your proposed use of the data requested will benefit Oklahoma public schools
school districts, public school students and/or their parents/legal guardians, public school teachers and/or
administrators, or the OSDE.
1
OFFICE of LEGAL SERVICES | APPROVAL FORM
III. INSTRUCTIONS FOR SUBMISSION OF REQUEST
All request for State Board of Education approval of disclosure, transfer, and/or sharing of de-identified individ-
ual student level data to or with unauthorized parties shall be submitted in writing to the OSDE Office of Legal
Services on this form via one of the following methods:
• Email: Kalee.Isenhour@sde.ok.gov
• Fax: (405) 522-6256
• Regular mail:
Oklahoma State Department of Education
Attn: Office of Legal Services
2500 N. Lincoln Blvd., Room 117
Oklahoma City, OK 73105
VI. SIGNATURE OF REQUESTING PARTY/AUTHORIZED REPRESENTATIVE
I hereby certify that the foregoing information is true and correct and that I am authorized to represent any
agency/entity/organization I have designated as the requesting party for purposes of this application.
Signature: _________________________________________________________________________________
Print Name and Title: ________________________________________________________________________
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OFFICE of LEGAL SERVICES | APPROVAL FORM
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