Principal Web-Based Survey

UNIVERSITY OF NORTH CAROLINA AT GREENSBORO
Professional Development Teacher Survey
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 to be part of the study based upon the grade and subject which he or she is
teaching. The participant is being asked to complete a survey of his or her experiences in
the training. The purpose of the survey is to understand what is covered in the training
and the benefits of the training on participants, not to evaluate individual teachers or
trainers. The survey should take no more than 15 minutes to complete.
RISKS AND DISCOMFORTS: It is not anticipated that there will be any risk or
discomfort associated with completing the survey.
POTENTIAL BENEFITS: It may be that completing a survey about the course will give
the participant the opportunity to reflect on the session. 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 them.
And, in general, the participant survey will permit AMSTI researchers to understand the
nature of AMSTI training, and fidelity to the policy and program goals of AMSTI.
COMPENSATION/TREATMENT FOR INJURY: There is no risk of injury as a result of
completing the survey.
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 completing the survey. 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 individually identifiable, or for his/her school being
individually identifiable. All data from this survey will be retained under secure
conditions 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

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be answered by calling Mr. Eric Allen at (336) 256-1482. Questions regarding the
research itself can be answered either 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 signifies agreement to participate in the project.
____________________________________
Participant's Signature*

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Date