Name of Researcher, Faculty, Department, Telephone & Email:
Gabrielle Wilcox, PsyD, NCSP, RPsych Werklund School of Education, School & Applied Child Psychology, 403.220.2534,
Frank MacMaster, Cumming School of Medicine, Department of Paediatrics, Department of Psychiatry
Erica Makarenko, PsyD, NCSP, RPsych Werklund School of Education, School & Applied Child Psychology

Title of Project:
Brain Development and Education Survey for Teachers


This consent form, a copy of which has been given to you, is only part of the process of informed consent. If you want more details about something mentioned here, or information not included here, you should feel free to ask. Please take the time to read this carefully and to understand any accompanying information.

The University of Calgary Conjoint Faculties Research Ethics Board has approved this research study (RED17-1255).

Purpose of the Study
The current study seeks to understand practicing and pre-service teachers’ knowledge about educationally relevant neuroscience and brain development. Teachers and pre-service teachers across North America will be asked to complete a short survey that includes demographic information and survey items (true and false questions), and a few open-ended questions. The results from this study will inform future teacher professional development in neuroscience.

What Will I Be Asked To Do?
As a participant, you will be asked to fill out a questionnaire that should take no longer than 10-15 minutes to complete. Information will first be collected regarding demographic factors (e.g., state or province, the grade(s) and subject(s) you are teaching, and how long you have been a teacher). In addition, we will ask you to complete a series of true and false questions related to educationally relevant neuroscience. Beyond this information no personal identifying information will be collected in this study, and all participants shall remain anonymous.

Participation in this questionnaire is completely voluntary. You may refuse to participate altogether, you may decline to answer any and all of the questions and you may withdraw your participation at any time without penalty.

Question Title

* 1. What Type of Personal Information Will Be Collected?
Should you agree to participate, you will be asked to indicate your gender, the state or province in which you teach, how long you have been teaching, and the grade level(s) you teach.

Are there Risks or Benefits if I Participate?
While there are no anticipated risks or discomforts to the participants, any participants feeling discomfort during the questionnaire are able to exit from the questionnaire at any time without penalty.

The online survey is being administered by SurveyMonkey©, an American software company. As such, your responses are subject to US laws, including the USA Patriot Act. The risks associated with participation are minimal, however, and are similar to those associated with using many email programs, such as gmail© and social utilities spaces such as Facebook©.

Participants will be provided with a link to a webpage that will provide a Questions and Answers about a variety of educationally relevant neuroscience topics. This link will be available in June of 2018. In addition, participants may experience the indirect benefit of understanding educationally relevant neuroscience more thoroughly after they have answered some questions about their understanding.

What Happens to the Information I Provide?
No one except the research team will be allowed to see any of the answers to the survey. There are no names or other identifying information on the questionnaire. Only group information will be summarized for any presentation or publication of results. 

If you have any further questions or want clarification regarding this research and/or your participation, please contact:

Dr.  Gabrielle Wilcox, PsyD
School & Applied Child Psychology
Werklund School of Education
403.220.2534 |

If you have any concerns about the way you’ve been treated as a participant, please contact the Research Ethics Analyst, Research Services Office, University of Calgary at (403) 210-9863; email

Selecting “I consent” on this page indicates that 1) you understand to your satisfaction the information provided to you about your participation in this research project, and 2) you agree to participate in the research project.

In no way does this waive your legal rights nor release the investigators, sponsors, or involved institutions from their legal and professional responsibilities. You are free to withdraw from this research project at any time. You should feel free to ask for clarification or new information throughout your participation.