1 

### Appendix A Approved Teacher Consent and Demographic Form

### APPROVED BY **INTEGREVIEW ETHICAL REVIEW BOARD**

**JULY 10, 2013**

2 **INFORMED CONSENT TO PARTICIPATE IN THE RESEARCH STUDY**  **Introduction** This project is intended to evaluate a mathematics professional development program (PD) for grade 4 teachers called Developing Mathematical Ideas (DMI). The research study will examine outcomes for both teachers and their students. There is currently little scientific evidence that math professional development provided to teachers actually helps to improve student achievement. This study hopes to fill in this important gap in our scientific knowledge of an important and wide-spread educational practice. This study is a randomized controlled trial, where schools will be randomly (like the flip of a coin) assigned to receive DMI, or to receive math PD as typically provided in the district. This type of experiment provides the strongest evidence of whether PD delivered to teachers may have an impact on student achievement. You cannot choose which education type your school will receive. **Study Funding and Personnel** This study is funded by Regional Educational Laboratory Southeast at Florida State University through a contract with the U.S. Department of Education and will be conducted by the employees and subcontractors of REL Southeast. **How Long The Study Will Last and How Many People Will Be In The Study** Fourth grade teachers in 84 rural, suburban and urban schools in 3 districts in South Carolina and in 3 districts in Georgia will participate in the study which will last about a year. **Confidentiality:** REL Southeast will protect the confidentiality of all information collected for the study and will use it for research purposes only. No information that identifies any study participant will be released. Information from participating institutions and respondents will be presented at aggregate levels in reports. Information on respondents will be linked to their institution but not to any individually identifiable information. No individually identifiable information will be maintained by the study team after approval of the final report. Staff working on the project have signed confidentiality pledges and been screened for data security through the U.S. Department of Education e-qip system. Only persons conducting this study and maintaining and monitoring its records will have access to the records collected that contain individually identifying information. REL Southeast will be following the new policies and procedures required by the Education Sciences Reform Act of 2002, Title I, Part E, Section 183 requires "All collection, maintenance, use, and wide dissemination of data by the Institute" to "conform with the requirements of section 552 of title 5, United States Code, the confidentiality standards of subsection (c) of this section, and sections 444 and 445 of the General Education Provision Act (20 U.S.C. 1232g, 1232h)." These citations refer to the Privacy Act, the Family Educational Rights and Privacy Act, and the Protection of Pupil Rights Amendment. Under the General Education Provision Act, Subsection (d) of section 183 prohibits disclosure of individually identifiable information as well as making the publishing or communicating of individually identifia ble information by employees or staff a felony. TID# _______

______ (for study staff only)

### APPROVED BY **INTEGREVIEW ETHICAL REVIEW BOARD**

**JULY 10, 2013**

3 The Institutional Review Board (IRB), IntegReview, and accrediting agencies may inspect and copy your records, which may have your name on them. Therefore, total confidentiality cannot be guaranteed. If the study results are presented at meetings or printed in publications, your name will not be used. **Benefits** If you choose to participate in this study and your school is placed in the experimental condition, you will be exposed to the DMI professional development, which may im prove your knowledge of teaching math and ability to teach mathematics. Your participation in the study will assist in evaluating the effectiveness of the DMI professional development. Information learned from this study may assist in the improved design of instruction for future mathematics education. **Alternatives To Participating In The Study** Since this study is for research only, the only other choice would be not to be in the study. **Costs** There will be no added costs for the curriculum and education and no additional costs for participation in this study. **Volunteering To Be In The Study** Participation of teachers in the study is voluntary and not a condition of employment. You do not have to participate in this study, and you can change your mind at any time. There will not be any penalty or loss of benefits to you if you decide not to pa rticipate in this study or to leave this study. If you leave the study early, you will be paid for each form/activity completed at the time of your withdrawal. If you want to stop participating in the study, tell the study staff and he or she will terminate your participation in the study. If you leave the study, no more information about you will be collected for this study. However, all of the information you gave us before you left the study will still be used for research purposes only. The information we collect, including student scores on the math test, will not be used to evaluate your performance. **Random Assignment and Time Commitment** This is a random assignment study, the gold standard of research designs. However this design is vulnerable to potential bias in the findings if participants know ahead of time what experimental condition they are in. This is because people may make different decisions on participation based on this knowledge, violating the intent that group membership be ‘random’ and not determined by other factors. Therefore we are asking that you commit to participation in the study before you know the experimental condition your school will be assigned to. **This is**  **critical for**  **the scientific**  **validit y**  **of t** **he results.**  The table below clearly lays out the time-commitment you will be agreeing to in advance, with the actual amount determined eventually by random assignment of your school. Ultimately the schools participating from your district will each be paired with a similar school in the district. Each school in the pair will have a 50% chance of being assigned to receive DMI, and a 50% chance of being assigned to the Control condition. It is important that you completely understand the time commitments for both conditions in this study before agreeing to participate. You are committing to participate in whichever condition your school is assigned to. TID# _______

______ (for study staff only)

### APPROVED BY **INTEGREVIEW ETHICAL REVIEW BOARD**

**JULY 10, 2013**

4 

### Time Commitments for each condition in the study. Participation Activities Time Commitment Condition DMI Control Consent & Demographic Form 10 minutes X X Teacher Knowledge, Pre- & Post-Test 2 X 2 hours Proctored on-site (+ transit time) X X DMI

– Sessions 8 X 3 hours Weekday (≈ 24 hours) X DMI

– Homework 7 X 3 hours (≈ 21 hours) X

 A total of 8 release days from instruction will be granted for DMI teachers to attend sessions and complete homework assignments. Monthly PD Survey 9 X 12 minutes Online X X Allowing student group to take post-test 45 minutes In classroom X X TOTAL Estimated participation time ≈ 52 hours ≈ 7

hours **Legal Rights** You will not lose any of your legal rights by signing this consent form.

**Consent for Participation**  I, _______________________________________, a 4th grade teacher at

________________________________________ hereby agree to participate in the Math Fractions Professional Development study, conducted by the Southeast Regional Educational Laboratory at Florida TID# _______

______ (for study staff only)

TID# _______

______ (for study staff only)

### APPROVED BY **INTEGREVIEW ETHICAL REVIEW BOARD**

**JULY 10, 2013**

5 State University, and its subcontractor Instructional Research Group, 4281 Katella Ave., Los Alamitos, CA. **Rem uneration:**  I understand I will be paid $150.00 for completing the forms and activities in the table on the previous page. This represents a typical rate paid in the state for time outside of the regular teacher contract with the district. Regardless of how much time is actually spent completing measures and activities, I acknowledge that these estimates were made in good faith by the research team and represent the remuneration I will be paid for participation, ifI complete all activities as scheduled. If I leave the study early, I will be paid for each form/activity completed at the time of my withdrawal. I understand that if my school is randomly assigned to participate in the PD condition, I will be granted by the district/school up to 8 release days from instruction to participate in 8 3 -hour DMI training sessions and subsequent required homework activities. **I further understand that my participation will continue only as long as it is mutually agreeable and that**  **I can**  **end my**  **participation at**  **any time.**  Final remuneration would, however, be based on the activities completed. I agree that study staff may contact me to follow-up on activities and for scheduling purposes. I was offered a copy of this consent form for my records. If I have further questions about this study or my rights, I can contact the study manager, Madhavi Jayanthi, by telephone at (7 14) 826-9600 or e-mail (madhavi@inresg.org). If I do not want to talk to the investigators or study staff, if I have concerns or complaints about the research, or to ask questions about my rights as a study subject, I may contact IntegReview. IntegReview’s policy indicates that all concerns/complaints are to be submitted in writing for review at a convened IRB meeting to:

### APPROVED BY **INTEGREVIEW ETHICAL REVIEW BOARD**

**JULY 10, 2013**

6 **Mailing Address: OR Email Address:** Chairperson IntegReview 3001 S. Lamar Blvd., Suite 210 Austin, Texas 78704 integreview@integreview.com
If I am unable to provide my concerns/complaints in writing or if this is an emergency situation regarding subject safety, I should contact their office at: 512-326-3001 or toll free at 1 -877-562- 1589 between 8 a.m. and 5 p.m. Central Time IntegReview has approved the information in this consent form and has given approval for the investigators to do the study. This does not mean IntegReview has approved my being in the study. I must consider the information in this consent form for myself and decide if I want to be in this study.

__________________________________ ________________________________________ Teacher’s Signature Date __________________________________ (Street) __________________________________ (City, State, ZIP) Phone and e-mail for follow-up: Phone: (__ __ __) __ __ __ - __ __ __ __ Email: __________________@___________.______ TID# _______

______ (for study staff only)7 **Teacher Demographic Questionnaire** This demographic questionnaire is to be completed at the same time as the consent form. All responses will held strictly confidential as described above. Name: _________________________________ School: _________________________________ Gender (Circle One) **Male Female**  Degrees (please list all completed, specifying major):

BA: __________________________________ MA: __________________________________ Post-MA: ______________________________ Other: ____________________________________________

____ Years Teaching In-service (please enter whole years, rounded up): Total Years of Classroom Teaching Experience ____ Total Years of 4th grade Classroom Teaching Experience ____ Total Years Teaching in Current School ____ Total Years Teaching Math in Middle/High School (Grades 6- 12) ____ Your certifications (please check all that apply): Elementary ____ Middle School

____ Mathematics

____ Math Specialist

____ Reading Specialist

____ Bilingual Education

____ Special Education

____ Speech/Language Specialist

____ Alternative Certification

____ Administrative

____ Other:

**______**

**____________________________** TID# _______

______ (for study staff only)