Informed Consent Form for Education Research
Purpose and Method
To gather information on student understanding of concepts and attitudes towards science, in the form of pre-test and post-test surveys. This information will be analyzed by instructors at Cuesta College, and at other institutions.
Nature of Participation
Completely voluntary, and personal information will be confidential. Credit for taking these surveys in a conscientious and serious manner will be given regardless of your consent, but it would be very helpful if you would be able to fully participate.
Potential Benefits and Outcomes
No immediate benefit, other than the personal satisfaction knowing that the results from these surveys will assist with assessing and improving instructional methods in science at Cuesta College, in comparison with other institutions.
Rights and Responsibilities
You may request your individual results from these surveys at any time by contacting the instructor (Dr. Patrick M. Len, pmL [at] waiferx.com). You may opt out at any later time by contacting the instructor.
Initial one of the following choices, then sign your name and date below.
_____My surveys can be analyzed for education research purposes, with complete confidentiality.
_____My surveys are not to be analyzed for education research purposes. (I will still receive course credit for taking them in a conscientious and serious manner.)
Participant name (print): ____________________
Participant signature: ____________________
A copy of this informed consent form is posted at:
Forms with no choice clearly initialed, or both choices initialed are considered "opt-outs." This form is given to the students at the start of the semester for the pre-tests, and again at the end of the semester for the post-tests. Usually three-quarters of the students opt-in at the start of the semester, and due to both attrition of opted-out students and changing attitudes, nearly all students still enrolled at the end of the semester remain or switch over to the opt-in choice.