Informed Consent Form - LIEPS to ED

Informed Consent Form

Language Instruction Educational Programs (LIEPs):

Lessons from the Research and Profiles of Promising Programs

Project Director: Rhonda L. Crenshaw, MA – Synergy Enterprises, Inc.

Principal Investigator: Ellen Forte, PhD – edCount, LLC

Introduction

You are invited to take part in a research study being conducted by Synergy Enterprises, Inc. and its subcontractor, edCount, LLC, on behalf of the US Department of Education. Your school/district is one of several across the country that is participating in a study of Language Instruction Educational Programs (LIEPs) for English learners (ELs). LIEPs are program models that consist of a comprehensive set of services including curriculum and instruction strategies as well as other essential services (e.g., counseling, family support, etc.) that facilitate English proficiency and academic content gains for English Learners (ELs).The major purpose of this exploratory study is to gather data from the field that yields an initial, descriptive portrait of well-designed and implemented LIEPs. This information will be used to create a Program Implementation and Evaluation for local educators seeking practical guidance on selecting, designing, implementing and evaluating LIEPs. The study is scheduled for completion in September 2012. Please read this form and ask any questions that will help you decide if you want to be in the study. Taking part in the research study is completely voluntary and even if you decide you want to participate, you can quit (withdraw) at any time. This consent form is signed by each individual interviewed as part of this study.

Procedures

The total amount of time you will spend in this study is approximately 60 minutes. This will involve face-to-face interviews. We will also spend time in your school building observing activities or events related to your LIEP such as classroom instruction, teacher planning sessions, and/or family support events.

Risks & Confidentiality

To reduce the risk of any individual’s name being connected with responses, the records of this study will be kept private. In any published articles or presentations, we will not include any information that will make it possible to identify any individual respondent’s specific quote or comments. The case studies will summarize findings across the sample and will not associate responses/quotes with a specific person from a district, school, or state. Synergy Enterprises Inc. (SEI) and edCount only will provide information that districts, schools, or state officials have provided during the interview. We will not release any information to anyone outside the study team, except as required by law.

Benefits

You will also be contributing insights that will be included as part of the project’s Program Implementation and Evaluation Guide. The information collected will be used to inform program policy and technical assistance in the coming years. Moreover, the Guide will be published and distributed to help other educators optimally serve EL students and their families.

Questions

You may talk to the research team if you have questions about the study. You can contact the Project Director, Rhonda Crenshaw, identified above on this form at 240.485.1700 or via email at rcrenshaw@seiservices.com. You may also call the project officer at the US Department of Education, Beth Yeh at 202.205.5798 or via email at beth.yeh@ed.gov.

Documentation of Consent

If you agree to take part in this study, please sign below:

Name: ______________________________________________________

Signature: ___________________________________________________ Date:_________________________

After you sign this Consent form and provide it to the research team, they will provide you with a copy. Please keep it in case you want to read it again or seek related information. Do not sign after expiration date of ________________[insert date]

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OMB Package as of March 24 2011 - 2