1. Consent to Take Part in this Survey

As a student whose class will engage in service learning, you are invited to join a study conducted by Dr. Lisa M. Dorner, Assistant Professor at UMSL (HSC Approval Number 100219D). This study will examine serving learning and civic engagement.

If you agree to be part of this study, you can expect: to complete one or two questionnaires. The questionnaires will take about 15 minutes to complete. Also, a research assistant may observe your class two or three times during the semester. Up to 900 students may be involved in this study.

All data from this study will be confidential and anonymous; no personal information from your survey will be shared with your instructor. Your name will not be used in any way. All data will be kept in a locked office or on a password-protected computer. Also, this study will not cost you anything, and you will not be paid for your participation. However, the results of this study will teach us about the effects of service learning. In turn, we may improve service learning.

Your participation is completely voluntary. You do not have to join this study, and you may leave it at any time. You do not have to answer all the questions. You will NOT be penalized if you do not join, or if you withdraw. Note: your choice to participate or not participate in this study will NOT affect your grade for this class.

We will do everything we can to protect your privacy. We will not reveal your name in any publication or presentation that may result from this study. In rare instances, a study must undergo an audit or program evaluation by an oversight agency. Such agencies must keep participants’ data confidential. If you have any questions or concerns about the study, please contact Dr. Lisa M. Dorner at 314.516.6437 or dornerl@umsl.edu. You may also ask questions or state concerns to the Office of Research Administration at 314.516.5897.

Please print this page to have a copy of this consent form for your records.

* 1. Please mark continue if you consent to take part in this survey, and then go to the next page.