Case Study Interview and Teacher/Parent Focus Group Consent Form

APPENDIX C:
CASE STUDY INTERVIEW AND TEACHER/PARENT FOCUS GROUP CONSENT FORM

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Interview Consent Form
Innovative Technology Experiences for Students and Teachers (ITEST) Evaluation

You are invited to participate in a research project to evaluate the Innovative Technology
Experiences for Students and Teachers (ITEST) program. Funded by the National Science
Foundation (NSF), this study is being conducted by SRI International (SRI) and Inverness
Research Associates (Inverness). Between January 2012 and June 2013, SRI and Inverness
staff will be conducting interviews and focus groups with ITEST principal investigators, project
staff, local project evaluators, project partners, and participants. During the interviews, we will
ask questions about how the project was planned, developed, and implemented; perceived
strengths and weakness of the project, aspects of the project that seem to be most beneficial to
teachers and/or students; and short and long term impacts of the project. In the focus groups,
we will ask about participants’ reasons for involvement in the ITEST project, frequency of
involvement in the project, and perceived benefits of participating in the ITEST project (short
and long term). The interviews and focus groups are intended to provide information about the
overall program and not to evaluate individuals or individual performance. The interviews will
last approximately one hour.

Confidentiality and Anonymity
We will treat the information you supply in a confidential manner except as may be required by
law. Only selected evaluation staff will have access to your actual interview responses. You will
never be identified by name in any report to the public or the National Science Foundation, but
you may be identified by title, e.g. ITEST principal investigator.
As part of the evaluation, the study team will be sharing its findings with the NSF. Findings
submitted to NSF will describe the characteristics of the ITEST projects and participant, the
impacts of the ITEST projects on students and teachers, and the characteristics of ITEST
projects that seem to be most effective in delivering desired students and teacher outcomes.
Reports released to the public will always use pseudonyms when referring to ITEST projects
and participating schools and districts.

Risks and Discomfort
There are no significant risks related to participation in this study. Participation in the study is
voluntary. You are free to cease participation at any time. If you decide not to participate you will
not be subject to any penalty.

Benefits
Your participation will contribute to the national study of the ITEST program and may inform
future improvements in to the ITEST program.

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More Information
For more information about this study, you may contact Dr. Marjorie Wechsler at
(650) 859-4822. For additional Human Subjects information, please contact the SRI Human
Subjects Committee at (650) 859-2686.

After receiving the information provided above and answers to my questions, I agree to
participate as a subject in the activity described. I understand that this is voluntary and is part of
a study sponsored by the National Science Foundation and conducted by SRI International and
Inverness Research Associates.
I consent to the use and publication of any data or other information resulting from my
participation, provided that I am not personally identified, except as may be required by law. I
further understand that additional information regarding the study will be available to me on
request and that I may withdraw my consent at any time.

____________________________________

_____________________________________

Signature of Interviewee

Date

____________________________________

_____________________________________

Title

Organization

___________________________________ ________________________________________
Signature of Interviewer

Date

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Appendix D:
Student Focus Group Consent Form

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[DATE]

Dear Parent or Guardian:
SRI International (SRI), a not-for-profit education research firm, is conducting a study that involves [NAME
OF SCHOOL OR ITEST PROJECT]. The study is evaluating projects funded by the National Science
Foundation’s (NSF) Innovative Technology Experiences for Students and Teachers (ITEST) grant program.
Your child has been selected to participate in a small group interview. The purpose of these small group
interviews is to ask students about their reasons for involvement in the ITEST project, frequency of
involvement, and perceived benefits of participating in the ITEST project (short and long term). The
interviews with students will be conducted in groups of approximately six to eight students. The interviews
will be conducted during [SCHOOL OR ITEST PROJECT] and will last no more than one hour.
The purpose of this letter is to ask for your permission to interview your child as part of this research activity.
We will not be administering any tests. Interviewers will audiotape and take notes during the interview
sessions, but there will be no record of comments attributable to individual members of the group. All
information will be kept confidential, stored in locked files on SRI premises, and destroyed at the conclusion
of the study. The information will be used only by SRI for this study.
Participation is completely voluntary: no students will be included without their parent’s permission. Your
child will not experience any negative consequences if he or she does not participate. In our reports, we will
not use any student’s name.
Your child’s [SCHOOL OR ITEST PROJECT] has approved our plans. If you have any questions about this
study, you may call Dr. Marjorie Wechsler at SRI International at (650) 859-4822.
Please be aware that under the Protection of Pupil Rights Act. 20 U.S.C. Section 1232(c)(1)(A), you have
the right to review a copy of the questions asked of or materials that will be used with your child. If you would
like to do so, you should contact Dr. Marjorie Wechsler (650) 859-4822 to obtain a copy of the questions.
If you agree to allow your child to participate in these research activities, please sign and return the next
page of this letter to [COORDINATOR OR OTHER APPROPRIATE PERSON] by [TWO WEEKS AFTER
DATE ABOVE]. Students will be selected for the small group interviews at random, from among those with
letters signed by their parents. If the letter is not returned to us, your child will not be selected.
We hope that you will allow your child to participate in this very important study.
Sincerely,

Patrick Shields
Principal Investigator
SRI International

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PARENTAL PERMISSION FORM FOR SMALL GROUP INTERVIEWS
Innovative Technology Experiences for Students and Teachers (ITEST) Evaluation
Purpose
This evaluation is being funded by the National Science Foundation. The evaluation is being carried out
by SRI International (SRI) and Inverness Research Associates.
The purpose of the evaluation is to improve the Innovative Technology Experiences for Students and
Teachers (ITEST) grant program. Toward that end, we are asking that several students participate in a
small group interview, during which time we will ask participants about their reasons for involvement in
the project, frequency of involvement, and perceived benefits of participating in the project (short and
long term). The group interviews will last no longer than one hour. The interviews are intended to
provide information about students’ experiences in the ITEST projects and not to evaluate the student’s
capabilities or performance.

Risks and Discomforts
There are no anticipated or known risks in participating in this study. Your child may ask to stop the
interview at any time without being penalized in any way.
Your child’s participation in the small group interview is voluntary. He or she will not be penalized in any
way for not participating in the interview.

Benefits
Your child’s participation in the small group interview will contribute to an understanding of the impacts
of ITEST projects on students’ interest in science, technology, engineering, and mathematics activities
and careers.

Confidentiality
We will treat the information your child supplies in a confidential manner, except as may be required by
law. We will audiotape and take notes during the interview, but there will be no record of comments
attributable to individual members of the group. We will not share your child’s responses with anyone at
[SCHOOL OR ITEST PROJECT], except as may be required by law.
Only selected evaluation staff will have access to the interview responses, and those data will be stored
on secure SRI computers and destroyed at the conclusion of the study. The data will be reported in a
manner that does not reveal your child’s identity.

More Information
For more information about this evaluation you can contact Dr. Marjorie Wechsler at SRI International
at (650) 859-4822. For questions regarding your child’s rights as a human subject participating in this
research, you may contact SRI’s Human Subjects Committee at (650) 859-2686.

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Informed Consent
By signing this form you are indicating that you have read and understood the information provided to
you about your child’s participation in the small group interview.

My child (name) _______________________________________________ can be interviewed in a
small group setting by SRI staff members about their school. I understand that this is voluntary and is
part of an evaluation funded by the National Science Foundation and conducted by SRI International
and Inverness Research Associates.

____________________________________
Signature of Parent or Guardian

___________________________
Date

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