Pennsylvania Physical Education Standards Survey
CONSENT FORM
Please click "Start Survey" at the bottom after reading this consent form.
Title: Implementation of the Pennsylvania State Standards for Physical Education
Researchers(s): Matthew Cummiskey, M.S., Department of Kinesiology (215) 204-1940, Pearson
Hall #140, Temple University, Philadelphia, PA 19122, Email: mdc49@temple.edu
Advisor: Ricky Swalm, PhD
CONSENT TO ACT AS A PARTICIPANT FOR RESEARCH
PURPOSE: The purpose of this study is to analyze how the Pennsylvania Academic Standards
10.4 and 10.5 for Health, Safety and Physical Education are being implemented and assessed in
the public schools.
SELECTION OF SUBJECTS: I understand that I have been chosen to participate in this study
because I a certified public school physical education teacher in the Commonwealth of
Pennsylvania.
GENERAL EXPERIMENTAL PROCEDURES: I understand that I will be required to complete the
following online survey. The survey will take approximately 5-15 minutes to complete. I may
provide additional information by answering the open-ended question at the end of the survey.
RISKS: There are no known risks associated with participating in this research study. If however,
any problems or concerns arise, I will contact the researcher.
BENEFITS: I will receive an email attachment describing the general results of the research.
CONFIDENTIALITY: I understand that my privacy will be maintained throughout the research and
publication process. Only the researcher and dissertation committee will have access to
participant information.
DISCLAIMER/WITHDRAWAL: It is understood that my participation is unconditionally voluntary
and I may at any time terminate my involvement. I understand that non-participation or withdrawal
from the research study will not prejudice future interactions with the investigator or Temple
University.
SUBJECT RIGHTS: I understand that if I wish further information regarding my rights as a
research subject, I may contact Richard Throm, Temple University Institutional Review Board
Coordinator at the Office of Vice President for Research by phoning (215) 707-8757. I also
understand that I may ask questions, and that my questions will be answered.
By clicking the “Start Survey” arrow, you indicate that you have read and understand this consent
form and that you voluntarily agree to participate in this study.
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Pennsylvania Physical Education Standards Survey
Welcome to the Pennsylvania Physical Education Standards Survey. Please respond accurately
to all survey questions so that we can arrive at a true understanding of how the standards are
being implemented. This study also involves teacher interviews and if you would like to be
contacted for a possible interview, please indicate your contact information at the end. All
information will remain completely confidential.
1
You are:
Male
Female
2
How many years have you been a full-time teacher in the public schools (enter the
number)?
3
Which grade level do you teach?
Elementary school (K-5)
Middle school (6-8)
High school (9-12)
Multiple levels
4
In what kind of setting is your school located?
Central city/urban
Urban fringe/suburb/large town
Rural/small town
5
How many physical education teachers are in your school (include yourself)?
6
Approximately how many students are in your school (enter the number)?
7
Approximately how many students are in your school district (enter the number)?
8
Is there a supervisor of physical education for your school district?
9
Is there a chair or head of the physical education department in your building?
10
How would you rate the performance of your school district on state exams against
other students in the state?
Above average
Average
Below average
11
I am a member of (check all that apply):
AAHPERD
PSAHPERD
Relevant Coaching Association
NEA/PSEA
12
Click the number which indicates whether you strongly disagree, disagree, agree, or
strongly agree with the statement.
1
2
3
4
Strongly disagree
Disagree
Agree
Strongly agree
I am familiar with Pennsylvania physical education standards 10.4 and 10.5.
I use the standards as a guide when creating lesson plans.
I incorporate the standards into my teaching.
I believe the standards are valuable.
I plan assessments which address the standards.
My students have met the grade level PA standards for PE.
Enough class time is allocated to physical education by my school district to achieve the
standards.
I coordinate with other physical educators in my school district regarding how to
implement the PA standards in class.
I improve my knowledge of the standards through workshops and professional
development.
Students in my classes have achieved the respective grade level standards.
The standards are making a positive difference in how “physically educated” my
students are.
The standards accurately reflect knowledge and skills which will be useful to students as
adults.
The standards are not of much use.
My students are aware there are state standards for physical education.
I understand the state’s physical education standards.
When drafting lesson plans, the standards help direct what I should cover or include.
My teaching reflects the standards.
The amount and frequency of physical education is sufficient to achieve the standards.
I work with other teachers in my district when deciding how to incorporate the standards
in class.
Due to the standards, how "physically educated" my students are has improved.
Workshops and professional development help me improve my understanding of the
standards.
Students in my classes have heard of the state standards for physical education.
The material covered by the standards will be valuable to students after high school as
adults.
The assessments I create are focused on the standards.
13
14
Please describe how you integrate the standards into your entire physical education
program (planning, teaching, assessing, other).
May we contact you for a possible follow-up interview?
15 If you answered "yes" above, please provide your name and contact information. This
information will not be disclosed to a third party.
Name:
Email Address:
Phone Number:
Work Zip Code:
Thank you for taking the time to complete the Pennsylvania Physical
Education Standards Survey. Your efforts will help improve physical
education for both teachers and students alike. Later this summer, you
will receive an email summarizing the results of this study. You are free
to share this information with students, colleagues, and other
professionals.
If you would like to contact me (mdc49@temple.edu) or my dissertation
advisor, Dr. Ricky Swalm (rswalm@temple.edu, 215.204.8713) for any
reason, please do not hesitate to do so. Best of luck with the standards
and the remainder of your school year.
Sincerely,
Matthew Cummiskey
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