Pacific Alliance forSupportingIndividualswith Disabilities in STEM Fields Partnership
CollegeStudent Participation Agreement
Staff from the Center on Disability Studies at the Universityof Hawai’i at Mānoa invite you to participate in the Pacific Alliance for Supporting Individuals with Disabilities in STEM Fields Partnership project (Pacific Alliance). The goal of Pacific Alliance is to significantly increase the participation of individuals with disabilities in Science, Technology, Engineering, and Mathematics (STEM) postsecondary degree programs and the STEM workforce in Hawai’i.
Through the project, you will have various opportunities to explore STEM activities and receive support to pursue a degree or a career in STEM (see Participant Activities and Supports).
Participation
You are eligible to participate if you:
- have a disability;
- are enrolled in or transitioning to a community college or a four-year university and intend to major in a STEM field; and
- intend to seek a STEM career.
The activities and supports are based on your learning and disability needs. This will be discussed and planned with you, the project staff, and your local Community ofPractice (COP). The COP members typically consist of: STEM instructors,disability service personnel, high school transition teachers, STEM employers, student services personnel, and students with disabilities. COP members are informed of your needs by the project staff and will meet at least two times a year to provide input on types of activities and supports relevant to your needs and feasible in their institutions.
Participant Activities and Supports
Some of the activities and supports available through the project are listed below. Types of activities and supports may vary depending on your needs and discussions with you, the project staff, and your local COP.
- Stipends for tuition, books, STEM related activities, assistive technology device, and transportation;
- Connecting to STEM-related activities and supports (including workshops) available in the community;
- Connecting to mentors who can help you explore accommodations, self-advocacy skills, assistive technology use, interest-building activities in STEM, and other topics;
- Connecting to academic support (e.g.,basic academic skill development and tutoring);
- Connecting to STEM-specific academic support (e.g., participating in STEM projects aligned with coursework); and
- Connecting to career-related supports(e.g., paid internships, research experiences, transition supports, and employment accommodations).
Length of Participation
Thisis a 3-year grant that may be extended for up to 5years. Participatingbeyond September 2012 will depend upon continuation of funding.
Yourconsent to participate is voluntary. You can end your participation at any time without any negative consequences. To end your participation just tell project staff that you no longer want to participate. You are not waiving any legal claims, rights, or remedies because of your participation in this research project.
Information (data) to be Collected
While you participate, your progress through the project services will be monitored, documented, and evaluated by the staff and yourself. If you agree to participate in the project, you will be asked to submit a demographic and past experience survey at the beginning of participation and a post survey at the end of the Spring, Summer, and Fall semester for which you participate. You can answer the surveys online or in hard copy, and each survey will take about15 minutes. You have the right to not answer any particular question. In addition, individual or focus group interviews will be conducted once or twice a year to obtain feedback and suggestions from you on the project activities for which you participated. For some of the activities or workshops, you may be asked to fill out a survey in order to evaluate the effectiveness of the activities or workshops.
All of thesurveys and interviews provide projectstaff with information about you and your participation in the project. This information will be used to evaluate the effectiveness of the project and improve the project activities and support provided to you and your fellow participants. All data gathered will be entered into a database to track your involvementandprogressinSTEM fields.
- Demographic and Past Experience Survey. This survey asks for information such as age, ethnicity, residency, disability condition, and level of schooling. In addition, the survey asks information about activities/supports you have taken part in before participating in the Pacific Alliance project, academic interests, level of interestin STEM fields, career goals, and reasons for participating in the Pacific Alliance project activities. This will be given to you at the beginning of participation.
- Post-survey. This surveyasks about your participation inproject activities, educational outcomes, and employment. This will be given at the end of every academic semester which is three times a year (May/June, August/September, and December/January).
- Interviews or focus groups. These will be conducted face-to-face once or twice a year to learn fromyou how to improve project activitiesand support through your experiences with Pacific Alliance. The individual interview will be approximately 20 minutes. If you participate inagroup interview (i.e., focus group), the interview will consistof3-5 other participants, and it will be approximately 45 minutes. Interviews and focus groups will be audio recorded and transcribed (written out) for further analysis. Names will not be used in the transcriptions or in any reporting.
- Activity/Workshop evaluation survey. This survey will take 5 minutes. It may include questions such as activity/workshop length, topic, room accessibility, and general feedback. No names will be collected.
Potential Risks
Otherpeople may find out information collectedthrough the project about you that you would like to keep private. To reduce this risk, project staffwill take the measures described below under“Confidentiality”.
Confidentiality
Allinformation about you will be kept strictly confidential to the fullextent allowed by law. Only project staff and an external evaluator will have access to this information. Information stored on computers will be protected with secret passwords. Other information (such as this consent formand other paper forms) will be keptin a lockedcabinet. A code number will be assigned to your data, and any personal identifiable information will never be published or disseminated. Participating COP members, including college personnel, will be asked to sign an agreement of confidentiality and will be bound by the conditions of the agreement.
Potential Benefits
Throughparticipation in this project, you may be connected tovarious activities and supports listed above, and you may receive stipendsto participate in these activities. These activities and supports may expand your opportunities to pursue a degree or career in a STEM field.
Compensation
Shortly after you submit each of the surveys, you will receive $250. Additional stipends may be available depending uponyour individual needs in pursuing a STEM degree or career. No other compensation will be provided.
Identification of Investigator
Ifyou have any questions, please contact:
Robert Stodden, Principal Investigator
Centeron Disability Studies
UniversityofHawai’i at Manoa
1776University Ave. UA4-6
Honolulu,HI 96822
(808) 956-9199
Forinformation on your rights as a participant,contact the UniversityofHawai’i at Mānoa Institutional Review Board, Human Protection Administrator, Jacob Kowalski at (808-956-7659)or .
Ifyou cannot obtain satisfactory answers to yourquestions or have comments or complaints about your treatment in this study, contact:Committee on Human Studies, Universityof Hawai’i, 1960 East-West Road, BiomedicalBldg., B-104, Honolulu, HI 96822. Phone: (808) 956-5007. E-mail:
Rev 1.23.12
Pacific Alliance forSupportingIndividualswith Disabilities in STEM Fields Partnership
AgreementtoParticipate
Bychecking “no”or “yes” and signing this formI indicate my understanding of the study/project. If I check “yes”, my signature also indicates my willingness to participateinproject activities and in the data collection methods outlined in this form as related to thePacific Alliance Project for Supporting Individuals with Disabilities in STEM Fields Partnership(Pacific Alliance)at the Center on Disability Studies,University of Hawai’i at Mānoa. If I choose not to participate I just check “no” below and provide my name.
Pleasecheck either “no”or “yes” below and sign this form.
_____ NO, I do not consent tomy participation in this study/project.
_____ YES, I certify that I have read and understand the information in this document. I have been given satisfactory answers to my questions concerning project procedures and other matters. I understand thatparticipation is voluntary and that I am free to withdraw my consent and to discontinue my participation in the research/project at any time without prejudice. I consent toparticipate in this research project with the understanding that such consent does not waive any of my legalrights, nor does it release the Project Director or the institution or any employee or agent thereof fromliability for negligence.
Signature
PrintedName
DatePhone number
* Check the box below if you agree to have your data contributed to the NSF database. The data being contributed will not be linked to any names, or other personal identifiers.
I agree to have my data contributed to the NSF database.
Pleasekeep this copy foryour records.
Rev 1.23.12
Pacific Alliance forSupportingIndividualswith Disabilities in STEM Fields Partnership
AgreementtoParticipate
Bychecking “no”or “yes” and signing this formI indicate my understanding of the study/project. If I check “yes”, my signature also indicates my willingness to participateinproject activities and in the data collection methods outlined in this formregarding thePacific Alliance Project for Supporting Individuals with Disabilities in STEM Fields Partnership(Pacific Alliance)at the Center on Disability Studies,University of Hawai’i at Mānoa. If I choose not to participate I just check “no” below and provide my name.
Pleasecheck either “no”or “yes” below and sign this form.
_____ NO, I do not consent tomy participation in this study/project.
_____ YES, I certify that I have read and understand the information in this document. I have been given satisfactory answers to my questions concerning project procedures and other matters. I understand thatparticipation is voluntary and that I am free to withdraw my consent and to discontinue my participation in the research at any time without prejudice. I consent toparticipate in this research project with the understanding that such consent does not waive any of my legalrights, nor does it release the Project Director or the institution or any employee or agent thereof fromliability for negligence.
Signature
PrintedName
DatePhone number
* Check the box below if you agree to have your data contributed to the NSF database. The data being contributed will not be linked to any names, or other personal identifiers.
I agree to have my data contributed to the NSF database.
Pleasereturn this page to Pacific Alliance staff,
Rev 1.23.12