Att_Supporting%20Statement%20B

UNIVERSITY OF NORTH CAROLINA AT GREENSBORO
Stand-alone Teacher Interview
CONSENT TO ACT AS A HUMAN PARTICIPANT
Project Title: The Evaluation of the Alabama Math, Science and Technology Initiative
Co-PIs: Dr. Denis Newman, Dr. Harold Wenglinsky
Participant's Name: _____________________________
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 has been
selected from a stratified random sample of 4th through 8th grade math and science
teachers in AMSTI schools to be part of the study. The participant will be involved in a
teacher interview. The teacher interview consists of open-ended questions about the
teacher’s background, instructional practices and the impact of AMSTI on students. 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: First, teachers will be given a small stipend in recognition of
their contribution to the study. Also, the teacher interview will give the teacher the
opportunity to reflect on his or her teaching. This increased reflectivity thus may be a
positive benefit. In addition, a sense that the system cares enough about what teachers
are doing with AMSTI to send an evaluator is probably reassuring to teachers. And, in
general, the interview will permit AMSTI to understand the nature of AMSTI classroom
practice, and 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; his/her 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 and from his/her school being identifiable. All
individually identifiable data resulting from this interview will be stored for a maximum
of ten years in a secure location 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 Denis Newman at 1-888-486-8886 x 127 or
Harold Wenglinsky at (212) 367-4615. 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 as described to by
_______________.
____________________________________
Participant's Signature*

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Date