INFORMED CONSENT DOCUMENT
Project Title: Analyzing Grades 4-6 Student Above-Level Assessment Scores
Investigators: Dr. Tyler Clark (Thomas.clark@wku.edu) and Dr. Julia Link Roberts (Julia.roberts@wku.edu)
Your child is being asked to participate in a project conducted through Western Kentucky University. The University requires that you give your signed agreement to allow your child/ward to participate in this project.
You may review the information below related to the project. If you have any questions, please contact Dr. Clark (Thomas.clark@wku.edu) or Dr. Roberts (Julia.roberts@wku.edu). If you indicate on the registration form that you have additional questions, Dr. Clark will reach out to you directly. A basic explanation of the project is written below. Please read this explanation and discuss with the researcher any questions you may have.
If you then decide to participate in the project, please sign below. Please print this page if you would like to keep a copy of this form.
1. Nature and Purpose of the Project: This project is designed to research fourth through sixth grade students participating in the Talent Identification Program of Kentucky (TIP-KY). Student demographic information and scores reported from the test and application materials will be used to better understand needs of advanced students.
2. Explanation of Procedures: You will complete the application for TIP-KY. After your child/ward takes the assessment, scores will automatically be available to TIP-KY for analysis.
3. Discomfort and Risks: There are potential educational records data privacy risks associated with student records; however, these risks are minor and comparable to other privacy risks with data records. TIP-KY only stores data in secure methods with restricted password access to staff who need to know specific information. Data is not shared without your explicit permission. The risks associated with participation in this research are minimal and no more than that encountered in everyday activities.
4. Benefits: The results from this work will have implications for understanding the needs of advanced students and performance of students taking above-level assessment. These results will be published at conferences and in journals.
5. Confidentiality: You and your child’s educator will receive individual interpretation reports (including name, grade, and composite and subject scores with service recommendations). The educator will also receive aggregate reports of students from their school taking the assessment. These reports are not a part of the research project. All other data collected will remain anonymous. Names of the students will not be included in any publication or presentation.
6. Refusal/Withdrawal: Refusal to participate in this study will have no effect on any future services you or your child may be entitled to from TIP-KY, The Center for Gifted Studies, Western Kentucky University, or your child’s school. Anyone who agrees to participate in this study is free to withdraw from the study at any time with no penalty.
You understand also that it is not possible to identify all potential risks in an experimental procedure, and you believe that reasonable safeguards have been taken to minimize both the known and potential but unknown risks.
THE DATED APPROVAL ON THIS CONSENT FORM INDICATES THAT
THIS PROJECT HAS BEEN REVIEWED AND APPROVED BY
THE WESTERN KENTUCKY UNIVERSITY INSTITUTIONAL REVIEW BOARD
Robin Pyles, Human Protections Administrator
TELEPHONE: (270) 745-3360