I understand that I have been asked to participate in a survey project designed to assess the impact of programs to encourage girls and minority students in science, technology, engineering, and/or mathematics (STEM) fields.
I understand that my participation involves filling out an initial questionnaire, which should take no more than fifteen minutes, providing background information about me and my family; and completing annual updates about my participation in STEM fields by filling out follow up surveys that will be mailed to me, which should take less than five minutes each. The follow up surveys are expected to continue for ten years. If the project is to last longer than that, I will be asked to consent to my continued participation.
I understand that my responses will be kept completely confidential by the program in which I am participating and by this assessment study run by Dr. Davis. Analysis of the data will not attribute information to individuals.
I understand that participation is voluntary. I have the right to refuse to participate in, or to withdraw from, this research at any time without prejudice and without any negative consequences. I also have the right to refuse to answer any question that I may not wish to answer.
I understand that Dr. Davis, who can be reached in the Computer Engineering Department at Santa Clara University, (email address: rdavis@scu.edu, telephone (408) 554-4358) will answer any questions I may have at any time concerning details of the data collected as part of this study.
Particiant's Name (Printed): ______________________________________________
Participant’s signature: ______________________________ Date: __________________
If Participant is a minor, a Parent or Guardian must also sign:
Yes, my child may participate.
Parent or Guardian Name (Printed) __________________ Signature: ________________________
No, my child may not participate.
Parent or Guardian Name (Printed) __________________ Signature: ________________________