UNIVERSITY OF HOUSTON 

CONSENT TO PARTICIPATE IN RESEARCH 

 

PARENTAL PERMISSION 

PROJECT TITLE: Strategies: St. Elmo Brady STEM Academy 

Thank you for allowing your child to participate in the St. Elmo Brady STEM Academy (SEBA). SEBA was created to expose underrepresented fourth and fifth grade boys to science, technology, engineering and mathematics (STEM) using an innovative approach with the hope of creating a community of young scientists who may one day consider STEM careers. Your child (or student) is being invited to participate in a research project conducted by Dr. Jerrod A. Henderson from the [Cullen College of Engineering] at the University of Houston. 

NON-PARTICIPATION STATEMENT 

Your child’s (student’s) participation is voluntary and you or your child (student) may refuse to participate or withdraw at any time without penalty or loss of benefits to which your child (student) is otherwise entitled. Your child (student) may also refuse to answer any question. A decision to participate or not or to withdraw will have no effect on your child’s (student’s) standing in the St. Elmo Brady STEM Academy. 

PURPOSE OF THE STUDY 

Because this is a novel program, research will be done to exam the quality and effectiveness of the program as well as determine the impact this experience has on the development of their interest in STEM. 

PROCEDURES 

Your child (student) will be one of approximately 20 subjects to be asked to participate in this project. As a part of this research, researchers plan to

Observe and videotape program participants via Zoom and take notes during program activities during two weeks each semester (a total of 6 observations per semester, 12 per year) 
 

Ask your child to participate in a survey (15 minutes per survey once a semester, twice during the year) 
 

Ask your child to participate in one interview via Zoom; the interview will be audio-recorded (30-35 minutes per semester, twice during the year) 
 

In year 3 only, we will request students’ STAAR scores from the school district

CONFIDENTIALITY 

Every effort will be made to maintain the confidentiality of your child’s (student’s) participation in this project. Each subject’s name will be paired with a code number by the researcher. This code number will appear on all written materials. The list pairing the subject’s name to the assigned code number will be kept separate from all research materials and will be available only to the researcher. Confidentiality will be maintained within legal limits. 

RISKS/DISCOMFORTS 

The risks involved in participation in this study are minimal. Interviews will be digitally recorded (audio only) and will be transcribed. A total of 12 sessions will be videotaped for further analysis. To minimize the risks of this research, all surveys, notes, and audio and video recordings will be kept on a password-secured server, and will be destroyed three years after the end of the study. Although interviews will be kept confidential, the nature of this type of interviews make it impossible for Dr. Henderson to guarantee that other participants will not discuss information outside the research context. 

 

BENEFITS 

While your child (student) will not directly benefit from participation in the research component, their participation may help investigators better understand the role of out of school experiences in helping underrepresented students become more interested in STEM. Participation in SEBA may help them become more interested in science and/or mathematics. 

ALTERNATIVES 

Participation in this study is voluntary and the only alternative is non-participation in the study. Non-participation in the study does not mean that your child/student will have to stop participating in the St. Elmo Brady STEM Academy. 

PUBLICATION STATEMENT 

The results of this study may be published in professional and/or scientific journals. It may also be used for educational purposes or for professional presentations. However, no individual subject will be identified. 

AGREEMENT FOR THE USE OF AUDIO AND VIDEO TAPES  

 

If you consent for your child to take part in this study, please indicate whether you agree to have them be audio and/or video- taped during the study by checking the appropriate box below. Interviews that are recorded will also be transcribed.  

If you agree, please also indicate whether the audiotapes can be used for publication/presentations. 
If you agree, please also indicate whether the data from the videotapes can be used for publication/presentations. 
Your child can still take part in the research if you do not agree to the audio or videotaping.

CIRCUMSTANCES FOR DISMISSAL FROM PROJECT 

 

Your child’s or student’s participation in this study may be terminated by the principal investigator  

if the principal investigator determines that staying in the project is harmful to your child or student’s health or is not in your child or student’s best interest; if your child or student decides not to participate in the SEBA after school program anymore or moves to a different school; if the study sponsor decides to stop or cancel the project.

SUBJECT RIGHTS 

1. I understand that parental consent is required of all persons under the age of 18 participating in this project. I understand that my child (student) will also be asked to agree to participate. 
 

2. All procedures have been explained to me and I have been provided an opportunity to ask any questions I might have regarding my child’s (student’s) participation. 
 

3. Any risks and/or discomforts have been explained to me. 
 

4. Any benefits have been explained to me. 

5. I understand that, if I have any questions, I may contact Dr. Jerrod A. Henderson at [713-743-4200].


6. I have been told that my child or I may refuse to participate or to stop his participation in this project at any time before or during the project. My child may also refuse to answer any question.

 

7. ANY QUESTIONS REGARDING MY CHILD’S RIGHTS AS A RESEARCH SUBJECT MAY BE ADDRESSED TO THE UNIVERSITY OF HOUSTON COMMITTEE FOR THE PROTECTION OF HUMAN SUBJECTS (713-743-9204).


8. All information that is obtained in connection with this project and that can be identified with my child (student) will remain confidential as far as possible within legal limits. Information gained from this study that can be identified with my child (student) may be released to no one other than the principal investigator [and his/her faculty sponsor]. The results may be published in scientific journals, professional publications, or educational presentations without identifying my child (student) by name. 

I agree to allow my child (student) to participate in this research project: 
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