Consent Form

Appendix E

Consent Form

University of North Carolina at Greensboro

CONSENT TO ACT AS A HUMAN PARTICIPANT

Project Title: SERVE @ UNCG REL-SE Needs Assessment Project

Project Director(s): Jane Curtis and Helen DeCasper

Participant’s Name: _____________________________________

DESCRIPTION AND EXPLANATION OF PROCEDURES:

The work of REL-SE, the Regional Educational Laboratory-Southeast (REL-SE), is revised each year to reflect the changing research and information needs of educators in the Southeast. In order to determine these needs, SERVE is required to conduct annual needs assessments of educators in Alabama, Florida, Georgia, Mississippi, North Carolina and South Carolina. As a part of this process, we are working with Curtis Research Associates to conduct research combining qualitative and quantitative methods using the Perception Analyzer™ (PA), sometimes referred to as interactive group testing. During a PA session research participants use hand-held dials to answer questions. As each question is answered, results are instantly tabulated and graphically displayed for immediate viewing by the moderator and participants. In addition, some open-ended questions may be asked, and these responses will be recorded by audio-tape.

RISKS AND DISCOMFORTS:

We anticipate no risk involved in participating in the group discussions and interactive group testing. No names will be associated with either the qualitative or quantitative data collected. The data collected will be stored in either the Curtis Research Associates office or the REL-SE office within locked cabinets for five years. All documents and data will be shredded or erased after the five-year term.

Responses to this data collection will be used only for statistical purposes. The reports prepared for this study will summarize findings across the sample and will not associate responses with a specific district or individual. We will not provide information that identifies you or your district to anyone outside the study team, except as required by law.

The meetings should take no longer than 2 hours

POTENTIAL BENEFITS:

The REL-SE responds to the information needs of educators by preparing Fast Response projects on education topics identified by educators throughout the Southeast. Each Fast Response project addresses a specific question which staff answers by locating, analyzing, synthesizing and reporting the best evidence available to answer the question. The resulting reports are made available to educators throughout the nation through the Regional Educational Laboratories’ website. Since the Fast Response projects must be completed in a year or less, new topics for study are needed every year. Through this project, the REL-SE staff will know the critical information needs of our various constituent groups and can respond to them annually.

CONSENT:

By signing this consent form, you agree that you understand the procedures and any risks and benefits involved in this research. 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.

The research and this consent form have been approved by the University of North Carolina at Greensboro Institutional Review Board, which insures that research involving people follows federal regulations. 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 Helen DeCasper by calling 800-755-3277.

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Signature of Participant Date

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egional Educational Laboratory