Consent for Educational Experiences at Harvey Mudd College

RESEARCH CONSENT FORM FOR STUDY PARTICIPANT

PROJECT TITLE: Educational Experiences at HMC

You are being asked to participate in a research project conducted by Dr. Debra Mashek in the Department of Humanities and Social Sciences at Harvey Mudd College. You are being asked to participate because you consented to participate in an earlier piece of the study and because you are currently enrolled at Harvey Mudd College .

PURPOSE:

The purpose of this study is to evaluate the educational experiences of students at Harvey Mudd and the influence these experiences have on students' personal growth and development.

PARTICIPATION:

During today's session you will be invited to complete a survey asking about your experiences and attitudes regarding your curricular and co-curricular experiences.
We expect your participation will take about 30- 50 minutes.
We will contact you again in one year to invite you to complete another survey.

RISKS:

The risks to participants are minimal. There are no foreseen risks from participation and the tasks involved in the study do not go beyond the typical thoughts, feelings, and activities individuals engage in on a daily basis.
It is possible that some participants may experience psychological stress as a result of thinking about their educational experiences, personal growth and development. Should you wish to talk to a professional therapist about your thoughts and feelings, I encourage you to call the Monsour Counseling Center at 909-621-8000.
Some of the questions ask about potentially sensitive topics (for example, use of illegal drugs). You may elect to skip any items you do not wish to answer.
I have conducted similar self-report studies. In no instance have I encountered any reports of participant discomfort or harm.

BENEFITS:

There are no direct benefits to participating in this study.
Participants may find rewarding the opportunity to reflect intentionally on their educational experience. They may also gain insights regarding the process of conducting psychological research.
To the extent the findings contribute to an understanding of student experiences at HMC, and to the extent these findings inform campus policies and practices, the study will potentially benefit future HMC students by further improving the campus experience.

COMPENSATION:

You will receive $10 as compensation for your participation in today's assessment.
You will receive an additional $10 if you elect to participate in next year's assessment.

VOLUNTARY PARTICIPATION:

Individuals must be at least 18 years old to consent to participate in this study.
Your participation is completely voluntary.
Your decision whether or not to participate will in no way affect your current or future relationship with Harvey Mudd College or its faculty, students, or staff.
Your grades in your courses are in no way influenced by participation in this study.
You have the right to withdraw from the research at any time without penalty.
You also have the right to refuse to answer any question(s) for any reason, without penalty.
There are no costs to you or any other party.
Any new information that may make you change your mind about consenting to participate in this study will be given to you.
You do not waive any of your legal rights by signing this consent form.

CONFIDENTIALITY:

The data in this study will be confidential.
The following procedures will be followed in an effort to keep your personal information confidential in this study:

You will use a self-generated password to log onto the study website for each survey. Although I will maintain a document linking your password with your contact information for the duration of the study, this document is kept in a secure location and will be destroyed upon completion of the study.
Any information obtained from the Registrar about your academic record or from the Deans about your institutional assessments will be coded only with your password. Your name will not appear on the sheets used to record this information.
While it is understood that no computer transmission can be perfectly secure, reasonable efforts will be made to protect the confidentiality of your transmission. We encourage you to use computers available in HMC labs to complete the assessments, thus ensuring IP addresses are not traceable to you. IP addresses are stripped from the data as soon as the data are downloaded.
All data (including electronic files) will be kept in a secured location.
Your individual privacy will be maintained in all publications or presentations resulting form this study.

To ensure that this research activity is being conducted properly, Claremont Graduate University 's Institutional Review Board has the right to review study records, but confidentiality will be maintained as allowed by law.

CONTACT INFORMATION:

If you have any questions or would like additional information about this research, please contact me at 909-607-0452, 301 Platt Blvd , Claremont , CA 91711 , mashek@hmc.edu.
The Claremont Graduate University Institutional Review Board, which is reviews HMC research involving human participants and is administered through the Office of Research and Sponsored Programs (ORSP), has approved this project. You may also contact ORSP at (909) 607-9406 with any questions.

PERMISSION TO CONTACT THE REGISTRAR:

During the course of the study I would like to contact the Registrar's office to obtain information contained in your academic record (i.e., enrollment status, GPA, academic standing, number of credit hours, types of courses taken, and SAT or ACT scores). This information will be recorded using study ID codes, not your name. Do you consent to allow the Registrar to provide this information to my research team? Please select your response:

Yes
No

PERMISSION TO OBTAIN INSTITUTIONAL ASSESSMENT DATA:

As a student at Harvey Mudd College , college administrators sometimes ask you to complete surveys; these surveys are forms of institutional assessment. Data from these assessments are managed by the Dean of Students and by the Dean of Faculty.

During the course of this study I would like to contact the Deans to obtain responses from institutional assessments you completed. This information will be recorded using study ID codes, not your name. Do you consent to allow the Dean of Students and the Dean of Faculty to provide this information to my research team? Please select your response:

Yes
No

CONSENT:

I encourage you to print a copy of this consent form for your records.

I understand the above information and have had all of my questions about participation on this research project answered. I voluntarily consent to participate in this research.

Your electronic signature (please type your full name):

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