Research Participant Consent Form: Principal Interview

OMB Number: xxxx-xxxx

Expiration Date: xx/xx/07

Appendix Y

Research Participant Consent Form: Principal Interview

UNIVERSITY OF NORTH CAROLINA AT GREENSBORO

Principal Interview

CONSENT TO ACT AS A HUMAN PARTICIPANT

Project Title: The Evaluation of the Alabama Math, Science and Technology Initiative

Co-PIs: Dr. Richard Sawyer, Dr. Denis Newman

Participant's Name: ­­­­­­­­­­­­­­­­­_____________________________

The collection of information in this study is authorized by Public Law 107-279 Education Sciences Reform Act of 2002, Title I, Part C, Sec. 151(b) and Sec. 153(a). Participation is voluntary. You may skip questions you do not wish to answer; however, we hope that you will answer as many questions as you can. Your responses are protected from disclosure by federal statute (PL 107-279 Title I, Part C, Sec. 183). All responses that relate to or describe identifiable characteristics of individuals may be used only for

statistical purposes and may not be disclosed, or used, in identifiable form for any other purpose, unless otherwise compelled by law. Data will be combined to produce statistical reports. No individual data that links your name, school name, address, telephone number, or identification number with your responses will be included in the statistical reports.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number.  The valid OMB control number for this information collection is XXXX-XXXX (expiration date: XX/XX/07).  The time required to complete this information collection is estimated to average 20 minutes, including the time to review instructions, search existing data resources, gather the data needed, and complete the information collection.  If you have any comments concerning the accuracy of the time estimate or suggestions for improving this form, please contact: the Department of Education 50 North Ripley Street PO Box 302101 Montgomery, AL 36104.  If you have comments or concerns regarding the status of your individual submission, e-mail directly to: rsawyer@aed.org.

DESCRIPTION AND EXPLANATION OF PROCEDURES: The purpose of the evaluation is to assess, through a randomized controlled experiment, whether AMSTI has a positive effect on classroom practice and student test scores. The participant will be involved in a principal interview. The principal interview consists of open-ended questions about the math and science instruction (AMSTI or other), the principal’s role as an instructional leader, and training and technical assistance experiences and needs of school staff. The interview should take no more than 20 minutes.

RISKS AND DISCOMFORTS: It is not anticipated that there will be any risk or discomfort associated with the interview.

POTENTIAL BENEFITS: The principal interview will give the principal the opportunity to reflect on his or her role as an instructional leader. This increased reflectivity thus may be a positive benefit. In addition, a sense that the system cares enough about what principals are doing with math and science instruction (AMSTI or other) to send an evaluator is probably reassuring to administrators. And, in general, the interview will permit AMSTI researchers to understand the implementation of math and science instruction (AMSTI or other) from a principal’s perspective, and specifically fidelity to the policy and program goals of AMSTI.

COMPENSATION/TREATMENT FOR INJURY: There is no risk of injury as a result of the interview.

CONSENT: By signing this consent form, the participant agrees that he/she understands the procedures and any risks and benefits involved in this research. He/she is free to

refuse to participate or to withdraw consent to participate in this research at any time without penalty or prejudice; participation is entirely voluntary. He/she is also free to ask any questions, either before or after the interview. His/her privacy will be protected because his/her identity will not be disclosed, except to researchers involved in the project, and any reports or publications that result from the study will be written to prevent his/her being identifiable or his/her school being identifiable. All individually identifiable data will be stored in a secure location for a maximum of ten years and then destroyed by shredding.

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 participant rights in this project can be answered by calling Mr. Eric Allen at (336) 256-1482. Questions regarding the research itself will be answered by calling Richard Sawyer at 202-884-8868 or Denis Newman at 1-888-486-8886 x 127. Any new information that develops during the project will be provided to the participant if the information might affect his/her willingness to continue participation in the project.

Signing this form constitutes agreement to participate in the project described by _______________.

____________________________________ ______________

Participant's Signature* Date

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egional Educational Laboratory