Ashford 6: – Week 5 – Journal
Signed Consent Form
Complete the required Informed Consent Form unless your planned intervention does not include anyone outside of yourself.
Informed Consent Form
Researcher Name:______________________________Researcher Email: ____________________
Researcher Phone: __________________
Location of Proposed Intervention/Innovation: ________________________________
This form serves two purposes; first, to acknowledge approval from the building principal or company supervisor for the researcher to conduct the proposed action research and second, to inform participants and/or parents/guardians of minor participants of the intentions of your study.
Student-researchers must submit this form if the proposed study involves any person(s) other than themselves for which a planned intervention or innovation will occur. Students using this form within a school setting or other place of employment must be a current employee at the site to seek permission to conduct action research at this location. A separate form must be provided to and signed by each parent or guardian of all minor (school-aged) children and/or adult participant involved in the study. Each signed form will be reviewed by the student-researcher’s employer as verification of participantacknowledgment.
Ashford instructors of EDU671 will store a back-up copy of this completed form in a secured drive, although it is the student researcher’s responsibility to save, store, and submit to their instructors of both EDU671 and EDU675 as required.
Purpose: The purpose of this research is to [insert your research questions and/or description]
Participation: You will be asked to
Voluntariness: Your participation in this research is strictly voluntary. You may refuse to participate at all, or choose to stop your participation at any point in the research without fear of penalty or negative consequence.
Confidentiality: The information/data you provide for this research will be treated confidentially, and all raw data will be kept in a secured file by the researcher. Personally identifiable information will not be shared.
Review of Research: You also have the right to review the results of the research if you wish todo so. A copy of the results may be obtained by contacting the researcher: [Researcher name and contact information]
I, (print full name) _________________ have communicated with the researcher during the planning stages of their proposed action research study and approve of their proposed study including the pending intervention/innovation to be conducted during their enrollment in the subsequent course; EDU675. My signature as the supervisor indicates the student conducting this proposed action research is an employee under my supervision. I further acknowledge receipt and viewing of all signed and returned Informed Consent forms completed by participants and/or adults of minor children participating in said action research intervention/innovation.
Name of Supervisor (please print)_______________________Position/Title:__________________________ Phone:__________________________ Email:________________________
To be completed by the Ashford, MAED student
As the student-researcher of EDU671, I (your name) _________________acknowledge and accept my responsibility to attain all signatures and submit the Informed Consent form to my instructor by Week Five of EDU671 and again during Week One of EDU675. I understand I will not move on to EDU675 and implement my proposed intervention/innovation unless the Informed Consent form is completed and submitted on time.
To be completed by the parent/guardian of minor participants and/or adult participants
I, (print full name) __________________________, have read and understand the preceding information explaining the purpose of this research and my rights and responsibilities as a subject and/or parent/guardian of a minor participant. My signature below designates my consent to participate in this research, according to the terms and conditions listed above.
Participant/Parent/Guardian Signature:_________________________________Date: ________________
EDU671 Instructor Verification
I (EDU671 instructor name)_____________________ verify that (student name) __________________ successfully completed and submitted the required Informed Consent prior to the end of EDU671 and has passed the final project as well as the course, confirming readiness for EDU675 and subsequent action research intervention/innovation.