Consent Form: Teacher Permission
Our goal at the __________________________________ is for every child to have a successful and enjoyable experience that helps to prepare him or her for the future. To help every child to meet this goal, we want to survey and interview the children who participate in our programs designed to improve education.
We
want to ask all Science teachers at _________________________________ about
their experience in our junior high science programs. With your permission, we will ask your students to complete a
questionnaire at two different times – after your students have completed a
formal scientific method write-up using traditional methods and later in the
year after your students have had a chance to utilize a web-based tool
developed to assist them in completing a formal scientific method write-up in
school. This tool will also be
available over the Internet from home for your student’s use and for you and
parents to review. It will take your
students about 15-30 minutes to do the questionnaire each time. The questionnaires are available for you to
look at. (Please contact
____________________________ if you would like to review them.)
In
addition, we ask your permission to compare the grades your students receive on
formal scientific method write-ups before and after they utilize the web-based
tool. We will ask you for the
grades. In addition to your permission,
we will also ask your child to consent to participate in the study. We will also ask the child’s parent to give
permission for them to participate in the study. We will be asking you to complete a questionnaire before and
after your students’ use of the web-based tool.
You
are free to withdraw your permission to participate at any time for any
reason. Your responses to the
questionnaire and grades will be kept completely confidential. The staff of the _____________________,
except for _____________________, will never see the individual responses of
any children or teacher participating in this study. Whether or not you give permission for yourself to take part in
the study will in no way affect your evaluation or participation in any science
class at __________________________________.
If
you have any questions, please call __________________________ the research
assistant in charge of this project.
I
have read and understand the above, and I voluntarily consent to participate in
this study.
________________________________________________________________________
Teacher
Signature Date
The Executive Secretary of the UIUC Institutional Review Board can answer any questions about the general rights of research subjects (417 Swanlund Bldg., 217-333-2670)