Teacher (Training Participant) Survey Grade 5 Science

Research Participant Consent Form: AMSTI Teacher Surveys
(Please submit completed and signed form to your principal)
Introduction
SERVE and its partners (Empirical Education Inc., Academy for Educational Development and
Abt Associates) are working with the State of Alabama Department of Education and your
school district to conduct scientifically based research on the effectiveness of AMSTI. The
Principal Investigators for this study are Dr. Denis Newman of Empirical Education and Dr.
Richard Sawyer of the Academy for Educational Development. As a teacher in one of the
participating schools you are invited to take part in this rigorous study, which will provide your
district and the state with important information. Your school will be part of the research project
for two years between 2006 and 2008.
AMSTI Study
Your school will be one of 40 schools state-wide assisting the state in determining the
effectiveness of AMSTI. From among the applicants this year, some of the schools were selected
randomly to begin AMSTI this coming school year (AMSTI First group) and some were selected
to begin AMSTI in the 2007-2008 school year (AMSTI Second group). The research will be
comparing the student achievement and teaching practices between the schools implementing the
AMSTI program and the schools that are not yet implementing AMSTI. Both groups are equally
important to the research, and the random assignment assures that the research results are
unbiased.
Summary of AMSTI Study Data collection
Researchers will be collecting administrative data (class rosters, student demographics and state
test scores) from your school system for grades 4 through 8. Teachers in grades 4 through 8 (for
both the AMSTI First and the AMSTI Second schools) will be asked to respond to web-based
surveys on a monthly schedule. For some teachers, additional classroom observations and
interviews will be conducted in the spring. Teachers who participate in the study for a whole
school year by completing web-based surveys will receive a $100 base honorarium per year.
Teachers who are also observed and interviewed will receive a total honorarium of $125 for that
school year.
Consent to Participate in AMSTI Study Teacher Surveys
This consent form asks teachers to consent to participate in the study’s web-based surveys.
Teachers who are asked at a later date to participate in classroom observations and/or interviews
will be given a separate consent form for those aspects of the research. A series of monthly
surveys will be sent to all participating teachers, January through April of 2006/07 and 2007/08.
We will send you an email that will have a web link you can click on to access each survey. The
surveys will help the researchers record the average amount of time spent on math and science,
program implementation and other factors that will contribute to the study. The surveys contain
up to 30 items and should take no more than 30 minutes. If a teacher has not yet submitted their
survey after 3 days of its distribution, they will be sent friendly reminders via email and/or
phone.
The research will not expose participants to any risks beyond the normal work of teaching and
learning. The benefit of participation is the opportunity to help provide evidence as to whether
the AMSTI program is effective. Continued participation in the research is voluntary. You may
refuse to answer particular questions. If you wish to withdraw at any time, you may do so
Approved by the University of North Carolina at Greensboro Institutional Review Board 8/26/06
Renew by 8/25/07

without penalty, except for the loss of the honorarium. If at anytime you have questions or
concerns, please feel free to contact: Denis Newman toll free at 1-888-486-8886 x 127.
It is important to understand that we are evaluating the AMSTI program and training and not
your teaching. Reports will not identify individuals or schools by name. Our company will
provide its services to your district in a manner consistent with the provisions of the Family
Educational Rights and Privacy Act (FERPA). All data provided to our company will remain the
property of your district, even while stored at our company's database. Our company will store
the data electronically in a secure location and take precautions to ensure the data is accessible
only to company personnel and consultants or to authorities legally authorized for access.
Personally identifying information will be removed so that students and teachers will be
identified only by unique numeric IDs within our company’s database. Unless otherwise
requested by your district, our company will retain the data in a secure location without
individual identification for use in re-analysis and follow-on research. All paper documents will
be shredded after 10 years. The district will be provided with a copy of the report, which will
include the objective evidence of the program’s effectiveness.
By signing this consent form, you agree that you understand the procedures and any risks
and benefits involved in this research, and that you agree to participate in the project
during the 2006-2007 school year. You are free to refuse to participate or to withdraw
your consent to participate in this research at any time without penalty or prejudice; your
participation is entirely voluntary. Your privacy will be protected because you and your
school will not be identified by name as a participant in this project.
The University of North Carolina at Greensboro Institutional Review Board, which
insures that research involving people follows federal regulations, has approved the
research and this consent form. Questions regarding your rights as a participant in this
project can be answered by calling Mr. Eric Allen at (336) 256-1482. Questions
regarding the research itself will be answered by Denis Newman by calling 1-888-4868886 x 127. Any new information that develops during the project will be provided to
you if the information might affect your willingness to continue participation in the
project.
By signing this form, you are agreeing to participate in the project.
____________________________________
Participant Name
____________________________________
Participant's Signature

______________
Date

Approved by the University of North Carolina at Greensboro Institutional Review Board 8/26/06
Renew by 8/25/07

Please provide the following contact information:
Teacher Name: _________________________________________________
School Name: ___________________________School System: _________________________
How can we contact you? Please supply the email address that is most convenient for you—
either your home or school email address. We will use this for distributing the surveys. If you
have no email, write “none”.______________________________________________________
Please supply phone numbers, including school, home, and mobile if possible, so that we can
follow up on surveys and schedule interviews. Indicate the phone number you prefer we try first,
and the best times to reach you at that number.
________________________________________________________________
________________________________________________________________
Please provide any other information about your availability and how we can best contact you.
________________________________________________________________
Please let us know about any questions you may have. Denis Newman at Empirical Education,
Inc., will respond to all questions promptly.
_________________________________________________________________
_________________________________________________________________
Research Participant Responsibilities: Surveys
All Participating Teachers
Substitute Teacher Participation. If you are out for more than a month, please notify a
research manager below and provide the name of the teacher who will be substituting for you.

Questions/Comments? Contact Information
Denis Newman
Email: lsterling@empiricaleducation.com
Phone number: 650-328-1734 x 127 (Pacific Time)
Toll-free phone number: 1-888-486-8886 x 127
Fax: 650-328-1794

Approved by the University of North Carolina at Greensboro Institutional Review Board 8/26/06
Renew by 8/25/07