Student Data Literacy Form

STUDENT DATA LITERACY FORM

Student Information

Student Name:

Parent / Guardian (If student is a minor)

Student is under 18 years of age:

Data Literacy Competency Checklist

Select the competencies you can demonstrate. Instructors may verify competency through assignment or assessment.

Can formulate meaningful, testable questions for data inquiry

Understands data collection methods and ethical considerations

Uses basic data management and documentation practices (file naming, metadata)

Uses spreadsheets to clean, summarize, and analyze data

Creates basic visualizations and interprets visual data representations

Understands central tendency, variation, and basic inference concepts

Recognizes sources of bias and principles of fairness and equity in data use

Tools Access & Permissions

Indicate which learning tools and data resources the student requires for coursework and projects. Access is granted subject to institutional policy and instructor approval.

Spreadsheet software (e.g., classroom spreadsheets)

Visualization and charting tools

Programming environment for data analysis (notebook or IDE)

De-identified datasets for class projects

Data Use and Privacy Acknowledgment

The institution collects and stores educational and operational data to support learning, evaluate programs, and comply with legal obligations. By signing this form, you acknowledge and agree to the following terms and conditions applicable to your use of student data and learning tools:

1. I understand that access to any student-level data is granted only for legitimate educational purposes and that personally identifiable information (PII) must be protected at all times. I will not attempt to re-identify individuals from de-identified datasets or share identifiable data outside authorized contexts.

2. I consent to the collection and use of my educational data for instruction, program assessment, and institutional research where necessary, subject to applicable institutional policy and legal protections for student privacy.

3. I acknowledge that misuse of data, including unauthorized disclosure, attempts to re-identify individuals, or noncompliance with data handling procedures, may result in disciplinary action in accordance with institutional policy and applicable law.

I certify that I will protect PII and comply with institutional data handling requirements.

I will not attempt to re-identify individuals in de-identified datasets and will report any data breaches or accidental disclosures promptly.

I consent to the use of my data for approved instructional and evaluative purposes as described above.

Training Completion & Certification

Students must complete the required data literacy training prior to accessing restricted datasets or advanced tools. Provide training details below. Instructors or data stewards may verify completion.

By signing this form I certify that the information provided is accurate and that I understand and will comply with the data use, privacy, and acceptable use provisions stated herein.

I acknowledge that access to datasets and tools may be revoked for failure to comply with policies and that training records may be retained to demonstrate compliance with program requirements.

Academic Policy Acknowledgment

I accept that misuse of data or academic dishonesty related to data assignments will be handled under the institution's academic integrity policy and may result in sanctions up to and including suspension or expulsion.

I acknowledge and accept the academic integrity and disciplinary provisions related to data use.

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