Research Participant Consent Form for AMSTI Principals

OMB Number: xxxx-xxxx

Expiration Date: xx/xx/07

Appendix X

Research Participant Consent Form for AMSTI Principals

(Principals: Please fax completed and signed form to Denis Newman at 650-328-1794.)

Introduction

SERVE and its partners (Empirical Education Inc., Academy for Educational Development and Abt Associates) are working with the State of Alabama Department of Education and your school system to conduct scientifically based research on the effectiveness of AMSTI. The Principal Investigators for this study are Dr. Denis Newman of Empirical Education and Dr. Sawyer of the Academy for Educational Development. As a principal in one of the participating schools you are invited to take part in this rigorous study, which will provide your school system and the state with important information. Your school will be part of the research project for two years between 2006 and 2008.

Assurance of Confidentiality

The collection of information in this study is authorized by Public Law 107-279 Education Sciences Reform Act of 2002, Title I, Part C, Sec. 151(b) and Sec. 153(a). Participation is voluntary. You may skip questions you do not wish to answer; however, we hope that you will answer as many questions as you can. Your responses are protected from disclosure by federal statute (PL 107-279 Title I, Part C, Sec. 183). All responses that relate to or describe identifiable characteristics of individuals may be used only for statistical purposes and may not be disclosed, or used, in identifiable form for any other purpose, unless otherwise compelled by law. Data will be combined to produce statistical reports. No individual data that links your name, school name, address, telephone number, or identification number with your responses will be included in the statistical reports.

Paperwork Reduction Act

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number.  The valid OMB control number for this information collection is XXXX-XXXX (expiration date: XX/XX/XX).  The time required to complete the survey is estimated to average 30 minutes, including the time to review instructions, search existing data resources, gather the data needed, and complete the information collection.  If you have any comments concerning the accuracy of the time estimate or suggestions for improving the survey, please contact: the Department of Education 50 North Ripley Street PO Box 302101 Montgomery, AL 36104.  If you have comments or concerns regarding the status of your individual survey submission, e-mail directly to: Laurel Sterling at lsterling@empiricaleducation.com or call toll free 1-888-486-8886 ext. 127.

AMSTI Study

Your school will be one of 80 schools statewide assisting the state in determining the effectiveness of AMSTI. From among the applicants this year, some of the schools were selected randomly to begin AMSTI this coming school year (AMSTI First group) and some were selected to begin AMSTI in the 2007-2008 school year (AMSTI Second group). The research will be comparing the student achievement and teaching practices between the schools implementing the AMSTI program and the schools that are not yet implementing AMSTI. Both groups are equally important to the research, and the random assignment assures that the research results are unbiased.

Researchers will be collecting administrative data (class rosters, student demographics and state test scores) from your school system for grades 4 through 8. Teachers in grades 4 through 8 (for both the AMSTI First and the AMSTI Second schools) will be asked to respond to web-based surveys on a monthly schedule. For some teachers, additional classroom observations and interviews will be conducted in the spring. Principals will be asked to participate in an interview and one web-based survey annually. Please refer to Research Participant Responsibilities page for a description of the activities required of participants.

The research will not expose participants to any risks beyond the normal work of a principal. The benefit of participation is the opportunity to help provide evidence as to whether the AMSTI program is effective. Continued participation in the research is voluntary. You may refuse to answer particular questions. If you wish to withdraw at any time, you may do so without penalty. If at anytime you have questions or concerns, please feel free to contact: Denis Newman toll free at 1-888-486-8886, x 127.

It is important to understand that we are evaluating the AMSTI program and training and not your work. Reports will not identify individuals or schools by name. Our company will provide its services to your school system in a manner consistent with the provisions of the Family Educational Rights and Privacy Act (FERPA). All data provided to our company will remain the property of your school system, even while stored at our company's database. Our company will store the data electronically in a secure location and take precautions to ensure the data is accessible only to company personnel and consultants or to authorities legally authorized for access. Personally identifying information will be removed so that students and teachers will be identified only by

unique numeric IDs within our company’s database. Unless otherwise requested by your school system, our company will retain the data without individual identification indefinitely for use in re-analysis and follow-on research. All paper documents will be shredded after 10 years. The school system will be provided with a copy of the report, which will include the objective evidence of the program’s effectiveness.

By signing this consent form, you agree that you understand the procedures and any risks and benefits involved in this research, and that you agree to participate in the project during the 2006-2007 school year. You are free to refuse to participate or to withdraw your consent to participate in this research at any time without penalty or prejudice; your participation is entirely voluntary. Your privacy will be protected because you and your school will not be identified by name as a participant in this project.

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 your rights as a participant in this project can be answered by calling Mr. Eric Allen at (336) 256-1482. Questions regarding the research itself will be answered by Denis Newman by calling 1-888-486-8886 x 127. Any new information that develops during the project will be provided to you if the information might affect your willingness to continue participation in the project.

By signing this form, you are agreeing to participate in the project described.

____________________________________ ______________

Participant's Signature Date

Research Participant Responsibilities

All Participating Principals

Surveys. A survey will be sent to all participating principals in July of 2007. We will send you an email that will have a web link you can click on to access the survey. The survey will help researchers to understand the implementation of AMSTI at your school. The survey contains up to 40 questions and should take about 30 minutes. If a principal has not yet submitted their survey after 3 days of its distribution, they will be sent friendly reminders via email and/or phone.

Questions/Comments? Contact Information

Principal Investigator: Denis Newman

Email: lsterling@empiricaleducation.com

Phone number: 650-328-1734 x 127 (Pacific Time)

Toll-free phone number: 1-888-486-8886 x 127

Fax: 650-328-1794

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