INSTITUTIONAL REVIEW BOARD

CONCORDIA UNIVERSITY
River Forest, IL

REQUEST FOR CONSIDERATION OF HUMAN STUDIES

1. Investigator(s):
a. Concordia University Principal Investigator(s): Ardelle Pate and university
instructors for course EDT 6070: Educational Technology Leadership

b. Principal Investigator(s) If Not Concordia University:

Principal Investigator(s) Contact Information:

● Telephone: 209-3638
● Email Address: ardelle.pate@cuchicago.edu
● Street Address: Christopher Center 238

c. Other CU Authorized Participants: Instructors for course EDT 6070

d. Non-CU Persons Involved (specify involvement):

2. Study Title: Needs Assessment assignment

3. Duration of Study:
a. Beginning Date: Summer, 2011 Academic Year

b. Completion Date: July 29, 2011

4. Location(s) of Study: On site at each graduate student’s school

5. External Sponsor and Funding:

a. Sponsor(s):

b. Funder(s):

6. Purposes/Objectives of Study:
As part of the EDT 6070: Educational Technology Leadership
course, students are to construct a needs assessment instrument
approximately 10 questions in length. Students are to administer the
instrument to 20 teachers or administrators, and analyze the results. The
purpose of the questionnaire is to gather needs assessment information to
determine an educational issue(s) that may require the school to design a
change initiative related to school improvement.
7. Design/Methodology of Study (including how subjects are selected):
Participants are teachers in District 300 who have voiced concern over
citation ethics and documentation skill instruction at the secondary level of
school. Participants will be given a survey through Google Forms to assess
their needs with documentation skill instruction.

Each graduate student will have no more than 20 subjects who have volunteered to
complete the needs assessment questionnaire.

8. Risks for Human Participants:

a. Potential Risks for Human Participants: none

b. How Risks Will Be Minimized: Each participant has the right to refuse
completing the questionnaire.

Each instructor for EDT 6070: Educational Technology Leadership will require
students to write an opening paragraph at the beginning of their needs assessment
questionnaire that will state the following:

“This questionnaire is part of my graduate course requirement. Participants will not be

identified and you have the right to refuse participation. Your participation is voluntary
and your completion of the questionnaire indicates your consent to participate. Results of
the questionnaire will not be published or publicly presented at any time and are for use
only in fulfilling the requirements of my graduate course.” (name of grad. student here)

9. Anticipated Benefits of the Study:

Students are being exposed to an “authentic” needs assessment process that
adds to the course content. Students will learn how to analyze the results of
their questions regarding topics related to school improvement and change
which may or may not include academic achievement.

10. Plan to Obtain Informed Consent:

(Attach copies of any forms and information sheets)
(Note method of securing assent if minors involved)

All students will be instructed to inform their school administration of their needs
assessment questionnaire and ask for signed permission (attached) to secure volunteers to
complete it. No one under the age of 18 will be asked to complete the survey.

11. Confidentiality of Data:

(Describe methods to ensure confidentiality, including the handling of all data once the
study is completed.)
Data will be handled by each individual student in the course and used as the basis to write a 3-4
page paper exclusive of the questionnaire. Individual participant results will remain anonymous.
The data will be destroyed at the completion of the study.

12. In accordance with Concordia’s Honor Code, turning in any piece of work with your
name
on it constitutes your pledge that you have not given or received any unauthorized aid.

13. Signatures:

Instructor: ________________________ Date: May 1, 2011

Investigator(s): ________________________ Date: _______________

________________________ _______________

13. IRB Reviewer: ________________________ Date: _______________

CURES – IRB –0806 (emb)