Science and Engineering Indicators Knowledge of Science Questions

ATTACHMENT B: COGNITIVE INTERVIEW CONSENT FORM
We would like to talk with you about a questionnaire Westat is developing for the U.S.
National Science Foundation. The questionnaire asks about your understanding of science. By
taking part in this interview, you are helping us evaluate how easy or difficult the questions are to
understand and answer. Your opinions will help us improve the questionnaire.
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Your participation is completely voluntary. You may stop at any time, and you can skip
any questions you do not wish to answer.
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All information obtained during this study will be treated as secure and will only be used
to develop and improve the questionnaire. We will not share your answers with anyone
outside of the research team.
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The interviewer will audio record the discussion and take notes. In addition, project
researchers may observe the interview. The researchers will destroy the audio recording
as soon as they complete the questionnaire development process.
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The interview should take about an hour.
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The report summarizing the findings will not contain any names or identifying
information.
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You will receive $40 cash as a token of our appreciation for completing the session.
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This study is authorized by law (42 U.S.C. 1862 Section 3.a.6.)
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This information is solicited under the authority of the National Science Foundation Act
of 1950, as amended, and the Confidential Information Protection and Statistical
Efficiency Act of 2002. The information you provide will be used for statistical purposes
only. Your responses will be kept confidential. Your response is voluntary and failure to
provide some or all of the requested information will not in any way adversely affect you.
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If you have questions about this research, please contact Robert Bell, the Principal
Investigator at (703-292-4977; rbell@nsf.gov). If you have questions about your role as a
research participant, please contact Sharon Zack, the Westat Institutional Review Board
Administrator (301-251-1500; sharonzack@westat.com).
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A copy of this consent form has been provided for your records.
If you agree to participate in this interview, please sign the following statement.
I have read this consent form and understand the proposed project. I consent to participate
in this study and to have the interview audio taped.
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Participant’s Signature

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Researcher’s Signature

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Printed Name

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Printed Name

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Date