Faculty Participations Consent Form

Kapi’olani Community College Professional Development Model – Collaborative Circle for Creative Change (C4wards) Evaluation Research

Primary Investigator:
Yao Zhang Hill, Ph.D
Institutional Researcher/Instructor
Office for Institutional Effectiveness
Kapi’olani Community College
Email: ofie@hawaii.edu
Phone: (808) 734-9763

To evaluate the short-term, mid-term, and long-term effects of Kapi’olani Community College professional development model – C4wards, we need your participation in our evaluation data collection.
You will be asked to participate in the following evaluation activities:
(1) Allow the use of the data on the Faculty C4wards Intake Survey collected by your concierge
(2) Allow the use of the Faculty C4wards Progress Survey collected by your concierge
(3) Allow the use of the Student Engagement Course Level Feedback Survey data from your students.
(4) Allow aggregated institutional data (e.g., grades, credits taken, course completion, transfer, certification, graduation status) of your students to be compared with the college benchmarks.

Please refer to C4ward Evaluation Confidentiality Policy on how your identity will be protected. Although your responses will be used to evaluate C4wards and in the evaluation report for the Title III grant, you have no obligation to permit the use of your data in the evaluation research of the professional development or in any publications or presentations. You can also withdraw from the research at any time by contacting the primary investigator and asking her not to use your data in any research publications. Your doing so will not affect your benefits and rights as a C4ward participants in any way. If you have any questions regarding the use of your data and the research please contact Yao Hill at ofie@hawaii.edu.

If you have any questions regarding your rights as a research participant, please contact the UH Committee on Human Studies at (808)956-5007 (808)956-5007 , or email them at uhirb@hawii.edu.

Please print this page of the consent form for your records.

Question Title

* 1. Please indicate whether you give consent for each of the following by putting your initials in front of the item and signing at the bottom.

Question Title

* 2. Your name (First M.I. Last):

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