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)

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. List the name, year and subject matter of the data file(s) you want to access.

2. What is your Project Title?

3. Briefly describe your research objective and how you will use the requested data.

4. Explain why the public-use files or the Data Analysis System (DAS) cannot meet your
research need.

5. Describe what kind of data you will link to the requested data (if any).

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 of the proposed users of the requested data.

User #1

First	Last	Title
	ext.
Office Address	Office Phone

User #2

First	Last	Title
	ext.
Office Address	Office Phone

User #3

First	Last	Title
	ext.
Office Address	Office Phone

User #4

First	Last	Title
	ext.
Office Address	Office Phone

User #5

First	Last	Title
	ext.
Office Address	Office Phone

User #6

First	Last	Title
	ext.
Office Address	Office Phone

User #7

First	Last	Title
	ext.
Office Address	Office Phone


Note: Access to the data is limited to only those persons who are listed here and who have a signed and notorized Affidavit of Nondisclosure.

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:
Project Title:
Research Objective:
Public Data:
Data Link:
Education Community:
Agreement Acceptance:
Time Frame:

Principal Project Officer (PPO)

Name

Title

Organization

Address

Phone

Fax

E-Mail Address

Senior Official (SO)

Name

Title

Organization

Address

Phone

Fax

E-Mail Address

Systems Security Officer (SSO)

Name

Title

Organization

Address

Phone

Fax

E-Mail Address

Principal Project Officer(PPO)

Senior Official(SO)

Systems Security Officer(SSO)

Modify Security Plan

NCES Headlines

Modify Security Plan
1. Describe the proposed modification to the previously submitted security plan.