TCUP Ecological Ahupuaʻa Monitoring in Urban Polynesia (TEAM-UP)

Consent Form: Math Emporium Immersion Model (MEIM) Program

University of Hawaiʻi

Kapiʻolani Community College

Math Emporium Immersion Model (MEIM) Student Consent Form

Consent to Participate in Research Project:

Math Emporium Immersion Model (MEIM)

The purpose of this research project is to evaluate the effectiveness ofKapiʻolani Community College’sMath Emporium Immersion Model (MEIM) program, as well as students’ experiences in the program. The semester-long programincludes three math courses (MATH 103, 135, and 140), an Undergraduate Research Experience (URE) course (SCI 295), and peer mentoring sessions.

You are asked to participate in thisresearch projectand its evaluation because you have been accepted to enrollin MEIM.

Project Description –Activities and Time Commitment: As a MEIMstudent, you are aware of the different courses and support resources that compose the program:MATH 103, 135, and 140; SCI 295; and peer mentoring sessions.In order to assess the effectiveness of MEIM, survey evaluations will be conducted throughout and at the end of the semester. The evaluation methods will include online and paper-based surveys.

Every Friday, you will take a brief survey that includes questions about the math course. At the end of the program, you will complete four surveys regarding your experience in MEIM, the value of specific components to you as a student, and your learning gains. Each survey will be administered by the Evaluation Specialist in either hard copy or online format and will take approximately 10 to 20 minutes to complete.

None of the survey data collected through this evaluation will be associated with your name. All survey participation is voluntary and the data will be anonymous and aggregated.

We will also collect information about your UHIDnumber,UH email address, ethnicity, major, class standing (freshman, sophomore, etc.), GPA, and grades obtained in the MEIM courses in addition toyour subsequent calculus courses when applicable to evaluate the efficacy of this preparation program.

Benefits and Risks: While it is believed that there are no direct benefits to you in participating in the surveys, your responses and the results of this project will help the Principal Investigator and other key members of the MEIM programdetermine how it can be improved. In addition, the weekly survey gives you a chance to convey your thoughts about the course to the instructor. The instructor may choose to make adjustments based on your feedback. It is believed there is little or no risk to you in participating in this project.

Participating in MEIM gives you,however,the opportunity to complete your calculus prerequisites in just one semester, which, in the traditional method, would take three semesters. In addition, you will benefit from support resources such as peer mentoring that can help you to complete the courses successfully and build skills that will prepare you for success in your chosen STEM pathway.

Confidentiality and Privacy: For the duration of the project, all paper data will be keptin a locked file cabinet until it isconverted to digital form and stored in anencrypted vault. All digital data will be encrypted in a vault file. All files will be stored in the Evaluation Specialist’s computer (password protected). The key to the encrypted vault will only be available to the Principal Investigator, Program Coordinator, and Evaluation Specialist. You will be assigned a random generated code number and the gathered information will only be linked to your code numbers and not directly to your identity. Only the Principal Investigator,MEIM Program Coordinator, and Evaluation Specialist will have access to the data, although legally authorized agencies, including the University of Hawaiʻi Committee on Human Studies, have the right to review research records.The Evaluation Specialist will scan the signed consent forms and save the digital copies in the vault. The original, paper versions will be shredded. The Evaluation Specialist will also collect information from the surveys and create a typed document to ensure that your handwriting will not be recognized and your responses will remain anonymous.Once tabulated, the original paper versions of the surveys will be shredded and the results will be saved digitally, aggregated, and encrypted.When the results of the research are reported,your name or any other personally identifying informationwill not be used;the findings will be reported in ways that protect your privacy and confidentiality.

Voluntary Participation: Participation in the evaluation is voluntary. You can freely decide or decide not to participate in surveys and allow the collection of information about your grades. Your decision to opt out of any or all parts of the evaluation at any time during the semester will not impact your performance in the courses. In addition, at any point during the semester, you can withdraw your permission without any penalty or loss of benefits.

Safety Monitoring: The University of Hawai’i Office of Research Compliance’s Human Studies Program requires that we monitor your safety to ensure that participants in MEIM are not experiencing greater harm than anticipated by researchers. If at any time during the program a problem or concern arises, please contact the Principal Investigator/Director Dr. Maria Bautista via phone (808) 734-9517 or email (), the Program Coordinator Dr. Hervé Collin via phone (808) 734-9265 or email (), or the Evaluation Specialist Kira Yamashita via phone (808) 734-9439 or email (). All situations will be handled in a manner that respects your privacy. Only concerned parties will be made aware of the situation, and once it is resolved, all information will be kept confidential.

Questions: If you have any questions about this project, please contact Dr. Maria Bautista, Dr. Hervé Collin, or Kira Yamashita (contact information listed above).If you have any questions about your rights as a research participant in this project you can contact the University of Hawai‘i Committee on Human Studies (CHS) by phone at (808) 956-5007 or by email at .

If you agree to participate in this project, please sign the following signature portion of this consent form and return it to the administering researcher.

Signature(s) for Consent:

I agree to participate in the research project entitled, “Math Emporium Immersion Model (MEIM).”I have read and understood the contents of the Math Emporium Immersion Model (MEIM) Student Consent Form,andI understand that I can change my mindabout participating in this project, at any time, by notifying the researcher.

Please check one:

___ Yes___ No I consent to allow the following information tobecollected for use in the MEIM project:UH ID number, UH email address, ethnicity, major, class standing (freshman, sophomore, etc.), GPA, grades obtained in MEIM courses, and grades obtained in subsequent calculus courses.

Print Participant Name: ______

Participant Signature: ______

Date: ______

A digital copy of this signed consent form will be provided to you for your records at your request.

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