Parent/Guardian Consent Form

Dear Parent and/or Guardian,

A University of Kansas research team is working on a new measure of self-determination (problem solving and goal setting). This is an approval for you to read and decide if your son or daughter might be interested in answering questions about making choices, setting goals and attaining goals for the future.

By accepting below, your child will spend 20 to 30 minutes to fill in items for the Self-Determination Inventory Self-Report (SDI-SR) measure we are developing and several other similar surveys we will use to help us make sure the SDI-SR is useful. This will help your child to think about choices, decision making, goal setting, and problem solving, but will also support other students later on after the SDI-SR is fully developed to have a way to measure the self- determination of all students across the country, ages 13 through 22 years.

If you have questions about this project, please contact one of the following University of Kansas researchers:

Sheida Khamsi at 785-864-2457
Susan Palmer at 785-864-0270

Thank you for considering participation in this study!

The Life-Span Institute at the University of Kansas (KU) supports the practice of protection for human subjects participating in research. You can decide if you wish your child to participate in this study. You can say no, and not allow your child to be in this study. Even if you say yes to allow your child to participate, you are free to withdraw your permission at any time. If you do withdraw your child from this study, it will not affect your relationship with your child’s school, the services it may provide to you or your child, or the University of Kansas.

We are developing a new measure of self-determination for youth and young adults between 13 and 22 years with and without disabilities. This Self-Determination Inventory Self-Report measure (SDI-SR) is about making choices, decisions, and setting goals, and will be helpful for educational planning and support when it is finished.Self-determination is about helping youth to be motivated to take a role in planning for the future and to set and achieve goals while in school and beyond.

The SDI-SR measure will be about:
• making choices and decisions when needed,
• personal control over actions, and
• belief that one has the capacity, opportunity, or ability to set and achieve goals.

Before, during Phase 1 of the study, we found the best questions to ask students to answer. Next, we asked students to answer these questions so we can make sure the SDI-SR provides a good way to measure self-determination. Now we need students to respond to the final survey items so that we can calibrate reliability (consistent results) and validity (how the survey compares to other short measures).
If you agree to have your child be a part of the study, your child will be asked to answer 94 questions on an online survey or paper survey about self-determination. They will spend about 20 to 30 minutes rating items about what they think about making choices, decisions, and goals. Your child can get help reading or marking their answers for the items on a computer or on paper, if that is needed or they ask for this. When each student signs in to the online measure or receives a paper survey, they are randomly provided with a selection of 94 items to answer. They will answer some items from the new measure and also items from the Agentic Engagement Scale, the Self-Regulation Scale, and the Basic Psychological Need Satisfaction Scale measures to help in our scale development.

Your child will be asked to give their name, grade, school name, and age/date of birth. Your child’s teacher may fill in information about your child’s course of study in school (college preparation, vocational, or diploma), and if your child has an IEP for special education services. Information provided by or about your child will be saved in a separate data file online and will not be linked with survey responses, except through an identification number assigned when the survey begins.

KU study personnel will mark consents with this code number and all signed consents will be kept in a locked file to keep these safe. No private information will be shared. If a student chooses, they can print out an overview of their self-determination after they take the online survey. If several students take the survey at your child’s school, we will share group summary data with the district to provide information to support better instruction in self-determination. No student names or individual scores will be given and only group data summaries will be shared.
No risks are anticipated for participation in this study. The information provided by and about your child will be immediately coded and handled carefully.

Your child will be part of a national study to help build a list of questions for a measure of self- determination that will help many people in the future in schools and in the community.

Your child's name or the name of your child’s school will not be used in any publication or presentation. We only describe group data – no individual information is shared. The researcher(s) will use a study number rather than your child's name. Your child’s identifiable information WILL NOT be needed to complete the study once we have assigned a study number and WLLL NOT be shared unless (a) it is required by law or university policy, or (b) you give additional written permission.

If you say it is all right for your child to answer questions on the surveys, your child’s information will be kept until June 2018 so that we can finish this work. By signing this form you are saying that it is all right to use your child’s information in a combined group data format, excluding name or school name, for purposes of this study until June 2018. After that time, the data will be archived or saved for use in ongoing data analysis. Any link to information that identifies any particular person will be destroyed as soon as data are entered into a secure database, immediately after your child answers the questions on self-determination.
You may refuse to sign this consent form without affecting your right to any services you are receiving from the school or the University of Kansas, or to participate in any programs or events of the University of Kansas. However, if you refuse to sign, your child cannot participate in this study.

Data will be collected until we have approximately 240 students who answer questions, probably by June 2017 at the latest. You may withdraw your consent to allow your child to be in this study at any time. You also have the right to cancel your permission to use information collected about your child, in writing, at any time, by sending your written request to:

Karrie Shogren, Ph. D. or Michael L. Wehmeyer, Ph.D. Beach Center-KUCDD
1200 Sunnyside Avenue
3136 Haworth Hall
Lawrence, KS 66045-7534

If you cancel permission to use your child's information, the researchers will stop collecting information about your child and will not use this information in the study.


Questions about procedures should be directed to the researchers listed below:
Sheida Khamsi, 785-864-2457,
Susan Palmer, 785-864-0270,

Beach Center on Disability & Kansas University Center on Developmental Disabilities
1200 Sunnyside Avenue, Room 3134 │ Lawrence, KS 66045-7534
Parent Consent Form for Students under age 18 years

HSCL # 00001305

I have read this Consent form. I have had the opportunity to ask, and I have received answers to, any questions I had about the study. I understand that if I have any more questions about my child's rights as a research participant, I may call (785) 864-7429, write to the Human Subjects Committee Lawrence Campus (HSCL), University of Kansas, 2385 Irving Hill Road, Lawrence, Kansas 66045- 7568, or email

I agree to allow my child to take part in this study as a research participant. When I electronically sign this form, I affirm that I am at least 18 years old and have received a copy of this Consent form.

* Do you agree to allow your child to participate in the research survey described above?

* Current Date


* Child's Name

* Parent/Guardian's Name

* Name of Your Child's School

Please provide your contact information for the purposes of sending the gift card and verifying participant contact information. We will not use your contact information for solicitation.

* Your Contact Information