Case Studies Consent Forms

Task Order 27
Study of Digital Learning Resources for
Instructing English Learner Students
Task 4.4 (Part 19) Case Study — Case Study Consent Forms

July 11, 2016

Submitted to:
U.S. Department of Education
Office of Planning, Evaluation and Policy Development

Submitted by:
Westat
1600 Research Boulevard
Rockville, Maryland 20850-3129
(301) 251-1500

Study of Digital Learning Resources for
Instructing English Learner Students
Task 4.4 ( Part 19) Case Study — Case Study Consent Forms

Prepared by:
Philip Vahey
Daniela Torre
Kaily Yee
Savitha Moorthy
Kea Vogt
SRI International
Annette Zehler
Eva Chen
Jennifer Flynn
Karin Katterfeld
Adrienne von Glatz
Westat
Yesim Yilmazel-Sahin
OneWorld Linguistic Consulting, LLC

Table of Contents
Informed Consent for Interviews .....................................................................................

1

Informed Consent for Observations ................................................................................

3

Study of Digital Learning Resources for Instructing English Learner Students

Case Study: Informed Consent for Interviews
Purpose
You have been selected to participate in a case study classroom observation that is conducted as part of
case studies included in the Study of Digital Learning Resources (DLRs) for Instructing English Learner
Students. This is a national study conducted for the U.S. Department of Education, Policy and Program
Studies Service by Westat and SRI International. The purpose of the research is to gain an understanding
of the current use of DLRs for instructing EL students and to develop guidance for teachers of English
learner (EL) students and for developers of DLRs for ELs. The information collected will be presented in a
final report as well as in two short field-focused toolkits or guides for educators and technology
developers.
To assist with the study, we are asking district administrators, principals, and teachers, along with other
relevant staff to participate in an interview as part of a three-day case study visit to your district. The
interviews will be on topics related to the use of DLRs in instruction, such as practices and training in
relation to the use of DLR, selecting and identifying DLRs for your school and/or district, and purposes or
goals for their use. The interviews are designed to last no more than one hour.
Risks and Discomfort
It is unlikely that you will experience any risks or discomforts associated with this interview. Your
participation in the interview is voluntary. If you decide to participate, you may discontinue your
participation in the interview at any time without penalty of any kind.
Benefits
Your participation in the evaluation will contribute to an understanding of the current use of DLRs for
instructing EL students and will help to provide guidance to teachers and developers of DLRs for ELs.
Freedom to Withdraw
Your participation in this research study is voluntary. You may choose to not answer any question that is
asked and you may discontinue the interview at any time.
Privacy
Responses to this data collection will be used to summarize findings in an aggregate manner (across
groups of sites), or will be used to provide examples of program implementation in a manner that does
not associate responses with a specific site or individual. In the report, pseudonyms will be used for each
site. The study team may refer to the generic title of an individual (e.g., “project director,” or “district
director”) but neither the site name nor the individual name will be used. All efforts will be made to
keep the description of the site general enough so that a reader would never be able to determine the
true name or identity of the site or individuals at the site. The study team will make sure that access to
all data with identifiable information is limited to members of the study team. The study team will not
provide information that associates responses or findings with a subject or district to anyone outside the
study team, and will protect or maintain confidentiality for data collected, except as required by law.

2

We would like your consent to record the interview, although you can participate in the interview but
decline to have it recorded. If you elect to have the interview recorded, you may stop the recording at
any time. Recordings will be kept in a secure location by SRI International and will not be accessed by
anyone outside the study team. The audio recordings will be destroyed at the conclusion of the study.
The recordings will be transcribed and a redacted transcription will be provided to the Department’s
Policy and Planning Studies Services. However, you can agree to having the interview recorded but
decline having the recording transcribed and provided to the Department.
Please check below to indicate your consent to one of the following interview, recording, and/or
transcription options as appropriate.
I agree to:
a. Be interviewed
b. Have the interview recorded
c. Have the interview transcribed
d. Have the redacted transcription provided to the U.S.
Department of Education.

☐ Yes
☐ Yes
☐ Yes
☐ Yes

☐No
☐No
☐No
☐No

More Information
If you would like more information about this study, you may contact the Deputy Project Director, Phil
Vahey, at SRI at 650-859-2143 or [email protected]. For questions regarding your rights as a subject
participating in this research, please contact SRI’s Human Subjects Committee: 650-859-2686 or [email protected], and refer to case # _____.
Informed Consent
I have read the above information. I have asked any questions I had and received answers. I consent to
participate in the study.
Signature: ___________________________________________ Date: __________________________
Print Name:__________________________________________

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of
information unless such collection displays a valid OMB control number. The valid OMB control number for this
information collection is xxxx-xxxx. Public reporting burden for this collection is estimated to average 60 minutes
per response, including the time to review instructions, search existing data resources, gather the data needed,
and complete and review the information collection. There is no obligation to respond to this collection;
participation is voluntary. If you have comments or concerns about the status of your individual submission of this
form, application, or survey, please contact [Name and Contact Information], U.S. Department of Education, Policy
and Program Studies Service, 400 Maryland Ave. SW, Washington, DC 20202, directly. (Note: Please do not return
the completed instrument, form, application, or survey to this address.)

3

Study of Digital Learning Resources for Instructing English Learner Students

Case Study: Informed Consent for Observation
Purpose
You have been selected to participate in a case study classroom observation that is conducted as part of
case studies included in the Study of Digital Learning Resources (DLRs) for Instructing English Learner
Students. This is a national study conducted for the U.S. Department of Education, Policy and Program
Studies Service by Westat and SRI International. The purpose of the research is to gain an understanding
of the current use of DLRs for instructing EL students and to develop guidance for teachers of English
learner (EL) students and for developers of DLRs for ELs. The information collected will be presented in a
final report as well as in two short field-focused toolkits or guides for educators and technology
developers.
The classroom observation is being conducted to assist us to understand how DLRs are used in various
classrooms that include ELs. The observations will last one class period. Our case study researcher will
confirm the time with you, will briefly discuss the session to be observed, and will agree with you on the
best way to schedule and ensure that the observation is not intrusive to classroom instruction.
Risks and Discomfort
It is unlikely that you will experience any risks or discomforts associated with this observation beyond
what is normal classroom and educational practice.
Benefits
Your participation in the observation portion of the case study will further contribute to an
understanding of the current use of DLRs for instructing EL students. It will provide an example of the
types of DLRs used, how they are used, and examples of students’ working with DLRs. The observation
information will enrich the full set of study findings to better inform the guidance to be developed for
teachers and for developers of DLRs.
Freedom to Withdraw
Your participation in the classroom observation is voluntary. If you decide to participate, you may
discontinue the classroom observation at any time without penalty of any kind. If at any point in the
classroom observation class period you become uncomfortable, you may request that our case study
researcher discontinue the observation and it will end without penalty to you for the discontinuation.
Privacy
Responses to this data collection will be used to summarize findings in an aggregate manner (across
groups of sites), or will be used to provide examples of program implementation in a manner that does
not associate responses with a specific site or individual. In the report, pseudonyms will be used for each
site. The study team may refer to the generic title of an individual (e.g., “project director,” or “district
director”) but neither the site name nor the individual name will be used. All efforts will be made to
keep the description of the site general enough so that a reader would never be able to determine the
true name or identity of the site or individuals at the site. The study team will make sure that access to
all data with identifiable information is limited to members of the study team. The study team will not

4

provide information that associates responses or findings with a subject or district to anyone outside the
study team, and will protect or maintain confidentiality for data collected, except as required by law.
More Information
If you would like more information about this study, you may contact the Deputy Project Director, Phil
Vahey, at SRI at 650-859-2143 or [email protected]. For questions regarding your rights as a subject
participating in this research, please contact SRI’s Human Subjects Committee: 650-859-2686 or [email protected], and refer to case # _____.

Informed Consent
I have read the above information. I have asked any questions I had and received answers. I consent to
participate in the study.
Signature: ___________________________________________ Date: __________________________
Print Name:__________________________________________

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of
information unless such collection displays a valid OMB control number. The valid OMB control number for this
information collection is xxxx-xxxx. Public reporting burden for this collection is estimated to average 60 minutes
per response, including the time to review instructions, search existing data resources, gather the data needed,
and complete and review the information collection. There is no obligation to respond to this collection;
participation is voluntary. If you have comments or concerns about the status of your individual submission of this
form, application, or survey, please contact [Name and Contact Information], U.S. Department of Education, Policy
and Program Studies Service, 400 Maryland Ave. SW, Washington, DC 20202, directly. (Note: Please do not return
the completed instrument, form, application, or survey to this address.)

5