EDT 6080 Applied Project in Educational Technology

Informed Consent

ADULT (18 or older)

I, ____________________________________ hereby give my consent to be a participant in

(Printed first and last name of Subject)
the study entitle Using Technology to Improve Documentation Skills conducted by Michelle Marconi, a
graduate student in the Masters of Educational Technology program at Concordia University Chicago.

I understand that if I agree to participate in this study, I will be asked to do the following: participate in a
professional development technology intervention study that addresses a preK-12 learning problem using
educational technology and assessments that measure learning.

I am aware that my participation is voluntary and may be withdrawn at any time without penalty or prejudice,
and that is I have any additional questions concerning this study, I may contact Researcher Michelle Marconi at
(224)-688-9523 and Professor Angela Tagaris (847)-977-3171. I understand that if I wish further information
regarding my rights as a research subject, I may contact Beth Becker, Assistant Director, Concordia University
Research & Evaluation Services / Office of University Services (CURES/OURS) (Elizabeth.Becker@cucchic-
ago.edu) at Concordia University Chicago at (708) 209-3020.

I have received clear information about the aims and methods of the research and understand that neither my
name nor any identifying characteristics will be identifiable in the study in order to protect my privacy. Results
of the assessment instruments and technology intervention tools will not be published or publicly presented at
any time and are for the use only in fulfilling the requirements of my graduate course EDT 6080: Applied
Project in Educational Technology from Concordia University Chicago.

I understand that the researcher will obtain my written consent if the data collected for this study is used beyond
the scope of the original project, including additional research papers, published articles, theses or visual or
verbal representation of the information that I have shared.

I understand that the intended benefits of this study include addressing a preK-12 learning problem.

The researcher has offered to share a copy of the finished product with me.

I understand that my consent to participate in this project does not constitute a waiver of legal rights or redress I
might have as a result of my participation, and I acknowledge that I have received a copy of this consent form.

______________________________________ __________________________
Signature of Subject Date

Approved by IRB 4/14/11