Informed Consent Form
TITLE OF STUDY:
The Impact of Connecticut’s State Education Resource Center’s (SERC) Professional
Development on the Quality of IEP Goals and Objectives
PURPOSE:
SERC is conducting a program evaluation of Designing Standards-Based IEPs for
Participation and Progress in the General Education Curriculum. The purpose of this
study is to provide SERC with critical information in terms of the impact and usefulness
of the tools and strategies presented in the training and will be used to drive the future
directions of SERC’s professional development. In addition, data collected will be used
to support a doctoral dissertation examining the impact of professional development on
IEP goals and objectives.
This study consists of:
 An interview regarding the quality of SERC’s professional development on
Designing Standards-Based IEPs for Participation and Progress in the General
Education Curriculum. The district can select one of the members of the team
that participated in the training to be interviewed and the interview will take
approximately one hour;
 The submission of fifteen (15) sets of sample IEP goals and their corresponding
objectives that were written by the participants prior to participation in the
professional development; and subsequently, the submission of fifteen (15) sets
of sample IEP goals and their corresponding objectives that were written by the
participants after participation in the professional development for a total of (30)
sets of sample IEP goals and their corresponding objectives. The sample IEP
goals and their corresponding objectives can be selected by the district. Only IEP
goals and their corresponding objectives are required for submission, not the
entire IEP. All identifiable student information must be removed before
submission;
 The submission of participant evaluations at the end of each session to be used in
the program evaluation of the professional development;
 The participation in an Educational Benefit Education Review Process as part of
the first day of the training and a subsequent day to be done in district after the
completion of the training. This process reviews a single student’s IEP over the
course of a three-year cycle. The products created in this process will be
transcribed and used in the study. All identifiable student information must be
removed before submission.
The analysis of this program evaluation will be used to evaluate SERC’s design and
delivery of the professional development for Designing Standards-Based IEPs for
Participation and Progress in the General Education Curriculum. The information will
be used to either affirm or revise the training design. The summary of SERC’s program
evaluation could potentially be used to develop new content for future professional
development regarding IEP development, including the sharing of on-line resources and
web-based professional development posted on SERC’s web site, http://ctserc.org/s/. A
summary of this program evaluation may also be posted on SERC’s web site.
Additionally information will also be used in a dissertation also evaluating the design and
delivery of the professional development for Designing Standards-Based IEPs for
Participation and Progress in the General Education Curriculum.
PROCEDURE:
I understand a member of my district will participate in an interview regarding the quality
of SERC’s professional development on Designing Standards-Based IEPs for
Participation and Progress in the General Education Curriculum. I understand that the
district can select one of the members of the team that participated in the training to be
interviewed and the interview will take approximately one hour.
I also understand that my district will submit fifteen (15) sets of sample IEP goals and
their corresponding objectives that were written by the participants prior to participation
in the professional development; and subsequently, my district will submit fifteen (15)
sets of sample IEP goals and their corresponding objectives that were written by the
participants after participation in the professional development. The sample IEP goals
and their corresponding objectives can be selected by the district. Only IEP goals and
their corresponding objectives are required for submission, not the entire IEP. I
understand that all identifiable student information must be removed before submission.
In addition, I understand that the team that attends Designing Standards-Based IEPs for
Participation and Progress in the General Education Curriculum will be submitting
participant evaluations at the end of each session to be used in the program evaluation of
the professional development. They will also be participating in an Educational Benefit
Education Review Process as part of the first day of the training and a subsequent day to
be done in district after the completion of the training. This process reviews a single
student’s IEP over the course of a three-year cycle. The products created in this process
will be transcribed and used in the study. I understand that all identifiable student
information must be removed before submission.
CONFIDENTIALITY AND/OR ANONYMITY:
I understand that all student identifiable information will be removed before submission
to SERC and therefore will not be disclosed in any published documents written about
this study. I further understand that all information shared with the researcher will be
strictly confidential and accessed only by the primary researcher and those directly
related to this study.
RISKS AND BENEFITS:
I understand that there are no known risks for participating in this study.
BENEFITS/RESULTS:
I understand that I may not receive any direct benefits from participating in this program
evaluation. However, I understand that the results may assist educators in the
examination of current local and state policies, practices, and philosophies regarding the
development of IEPs. I understand that the information collected during this study will
be used in a doctoral dissertation. The district or team that is participating in the
professional development can request a summary of the program evaluation upon its
completion. The work submitted for this study can also be used for the application of
learning required for CEUs.
VOLUNTARY PARTICIPATION:
I understand that my participation in this study is voluntary. I understand that I may
discontinue my participation in this study at any time without any penalty or prejudice. I
also understand that there is no compensation in return for my participation.
CONTACT INFORMATION:
Should you have any questions about this study, please do not hesitate to contact Dr.
James Tucker, Advisor, at P.O. Box 15188, Chattanooga, TN 37415 or by phone at (423)
425-5261, or Kimberly A. Mearman at SERC, (860) 632-1485, ext. 314 or
mearman@ctserc.org.
Signatures of Participating Team Members:
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Signature of Team Member
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Signature of Team Member
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Signature of Team Member
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Signature of Team Member
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Signature of Team Member
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Signature of Team Member
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Witness
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Date
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Agreement of the Superintendent
I understand the purpose and the terms of SERC’s study and I agree to support the above
district personnel in the participation of this study.
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Signature of Superintendent
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Witness
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Date
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 I would like to be provided a summary of SERC’s program evaluation.
Signature of Researcher:
I have reviewed the contents of this form with the person signing above. I have explained
potential risks and benefits of this study.
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Signature of Researcher
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Date