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Meca-Consent Form Template

This document provides an informed consent form for participants in a research study conducted by researchers at Old Dominion University. The study aims to examine pre-service teachers' perceptions of multicultural education before and after completing discipline-specific writing assignments. It involves no risks beyond those encountered in everyday life. Participants may benefit from improving their writing and reflecting on their teaching beliefs and practices. The study will last one semester and involve around 70 pre-service teacher candidates. Participation is voluntary and participants' information will be kept confidential.

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249 views2 pages

Meca-Consent Form Template

This document provides an informed consent form for participants in a research study conducted by researchers at Old Dominion University. The study aims to examine pre-service teachers' perceptions of multicultural education before and after completing discipline-specific writing assignments. It involves no risks beyond those encountered in everyday life. Participants may benefit from improving their writing and reflecting on their teaching beliefs and practices. The study will last one semester and involve around 70 pre-service teacher candidates. Participation is voluntary and participants' information will be kept confidential.

Uploaded by

api-253699482
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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INFORMED CONSENT DOCUMENT

OLD DOMINION UNIVERSITY


PROJECT TITLE: M.E.C.A. (Multicultural Education in the Content Areas): Improving Preservice Teachers’ Disciplinary
Writing through Multicultural Education

INTRODUCTION
The purposes of this form are to give you information that may affect your decision whether to say YES or NO to
participation in this research, and to record the consent of those who say YES. The M.E.C.A. (Multicultural Education in
the Content Areas): Improving Preservice Teachers’ Disciplinary Writing through Multicultural Education research project
will take place during the course of your semester and will take place on campus at Old Dominion University.

RESEARCHERS
Kristie Gutierrez, Assistant Professor of Science Education, Department of Teaching and Learning in the Darden College
of Education
Jori Beck, Assistant Professor of Secondary Education, Department of Teaching and Learning in the Darden College of
Education
Kelly Rippard, Lecturer, Instructional Technology, Department of Teaching and Learning in the Darden College of
Education
Yonghee Suh, Graduate Program Director and Associate Professor of Social Studies/History Education, Department of
Teaching and Learning in the Darden College of Education
KaaVonia Hinton, Department Chair and Professor of English Education, Department of Teaching and Learning in the
Darden College of Education

DESCRIPTION OF RESEARCH STUDY


Several studies have been conducted looking into the subject of improving pre-service teachers’ understanding of
multicultural education and the types of discipline specific writing required of them once they enter the teaching
profession. None of them have explained the pre-service teacher candidates’ perceptions of multicultural education before
and after they complete discipline specific writing.

If you decide to participate, then you will join a study involving research of perceptions of multicultural education. If you
say YES, then your participation will last for the duration of the class semester on campus at Old Dominion University.
Approximately 70 other pre-service teachers from Old Dominion University will be participating in this study.

EXCLUSIONARY CRITERIA
You should be enrolled in TLED 360, TLED 430, TLED 451/551, TLED 455/555, or STEM 453/553.

RISKS AND BENEFITS


RISKS: If you decide to participate in this study, then you may face no risk. However, as with any research, there is
some possibility that you may be subject to risks that have not yet been identified. Additionally, all data received will be
stripped of personal identifiers prior to analysis and will be stored securely in a password protected folder on a secure
server.

BENEFITS: The main benefit to you for participating in this study is to help improve disciplinary writing and multicultural
education, and reflect on your beliefs and practices as a future teacher.

COSTS AND PAYMENTS


The researchers want your decision about participating in this study to be absolutely voluntary. Yet they recognize that
your participation may pose some inconvenience. In order to thank you for your time, participants chosen to participate in
the focus groups will receive $20 in cash.

NEW INFORMATION
If the researchers find new information during this study that would reasonably change your decision about participating,
then they will give it to you.
CONFIDENTIALITY
The researchers will take reasonable steps to keep private information confidential. The results of this study may be used
in reports, presentations, and publications; but the researcher will not identify you. Of course, your records may be
subpoenaed by court order or inspected by government bodies with oversight authority.

WITHDRAWAL PRIVILEGE
It is OKAY for you to say NO. Even if you say YES now, you are free to say NO later, and walk away or withdraw from the
study ‑ ‑ at any time. Your decision will not affect your relationship with Old Dominion University, or otherwise cause a
loss of benefits to which you might otherwise be entitled.

COMPENSATION FOR ILLNESS AND INJURY


If you say YES, then your consent in this document does not waive any of your legal rights. However, in the event of a
problem arising from this study, neither Old Dominion University nor the researchers are able to give you any money,
insurance coverage, free medical care, or any other compensation for such injury. In the event that you suffer injury as a
result of participation in any research project, you may contact Dr. Kristie Gutierrez at 757-683-4975 or Dr. Laura C.
Chezan, the current IRB chair at 757-683-7055 or lchezan@odu.edu at Old Dominion University, or the Old Dominion
University Office of Research at 757-683-3460 who will be glad to review the matter with you.

VOLUNTARY CONSENT
By signing this form, you are saying several things. You are saying that you have read this form or have had it read to
you, that you are satisfied that you understand this form, the research study, and its risks and benefits. The researchers
should have answered any questions you may have had about the research. If you have any questions later on, then the
researchers should be able to answer them:

Kristie Gutierrez, 757-683-4975


Jori Beck, 757-683-3392
Kelly Rippard, 757-683-5277
Yonghee Suh, 757-683-6697
KaaVonia Hinton, 757-683-5958

If at any time you feel pressured to participate, or if you have any questions about your rights or this form, then you should
call Dr. Tancy Vandecar-Burdin, the current IRB chair, at 757-683-3802, or the Old Dominion University Office of
Research, at 757-683-3460.

And importantly, by signing below, you are telling the researcher YES, that you agree to participate in this study. The
researcher should give you a copy of this form for your records.

Subject's Printed Name & Signature


Date

INVESTIGATOR’S STATEMENT
I certify that I have explained to this subject the nature and purpose of this research, including benefits, risks, costs, and
any experimental procedures. I have described the rights and protections afforded to human subjects and have done
nothing to pressure, coerce, or falsely entice this subject into participating. I am aware of my obligations under state and
federal laws, and promise compliance. I have answered the subject's questions and have encouraged him/her to ask
additional questions at any time during the course of this study. I have witnessed the above signature(s) on this consent
form.

Investigator's Printed Name & Signature Date

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