Consent Form

Dear Scaling to Petascale Institute Participant,

Thank you for signing up to attend the Scaling Petascale Institute. Because this is a new program, an evaluation team will be examining the quality and effectiveness of this program from the perspectives of participating members.

This evaluation study will be conducted by Dr. Lizanne DeStefano and her team at the University of Illinois at Urbana-Champaign. Evaluation results will be shared with the program leadership in a way that will not identify any participant. We hope that this evaluation will contribute to program improvement and further development of this program. Lessons learned from the evaluation may also be reported in scholarly articles that will not include identifying information about participants.

In this confidential survey, we would like to hear about your experience as a participant in this event. This questionnaire should take 10 minutes to complete.

Your participation in this evaluation is completely voluntary and you may stop participation at any time and for any reason without penalty. You are free to skip any question, including background questions. Choosing not to participate will not result in any negative impact on your current or future membership or employment status with Blue Waters or this event. The survey is confidential, no names or other identifying information will be reported. The program organizers will not know about your decision to participate or not participate in our study. All evaluation data will be kept in a secure location, will only be accessible to members of the evaluation team, and will be coded to remove any identifying information. Please only participate if you are age 18 or older.
If you have any questions about your rights as a participant in this study or any concerns or complaints, please contact the University of Illinois Institutional Review Board at 217-333-2670 (collect calls will be accepted if you identify yourself as a research participant) or via email at

If you have any questions about this study, you may contact Jung Sung or at 217-333-9625. You may print this screen for your records.

Thank you for your consideration,

Lizanne DeStefano, Executive Director of CEISMC
Georgia Institute of Technology