Consent Form(Person-in-charge)

Definition and purpose of study:
Many programs are intended to encourage girls and minority students to pursue Science, Technology, Engineering and Mathematics (STEM). This study is intended to keep track of participants in such programs, following them through their educational and work careers to assess the impact of the programs in which they participated. An initial survey requests demographic background and contact information. Annual follow up surveys track current majors and participation in STEM fields.

I understand that I am in charge of organizing the participation of my students in the in this 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 the participation of my students is voluntary, and this is ensured by having each  participant (and parent, if student is a minor) sign a consent form. I agree to send the signed consent forms or a copy of them to Dr.Davis. I agree to give out the password enabling access to the online survey forms only to the participants who have submitted their properly executed consent forms.

I understand that all the information the participants provide must be kept confidential and access to the data is restricted. I will receive a copy of the raw data only from my program and will have restricted access to the data from other programs.

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.
 

Name (Printed): ______________________________________________
 
 

Signature: ______________________________              Date: __________________