California State Polytechnic University, Pomona
Informed Consent for Research Involving Human Subjects

You are being invited to participate in a research study. This form is designed to provide you with information about this study. The Principal Investigator or representative will describe this study to you and answer any of your questions (Dr. Janine Riveire, (909) 869-XXXX). If you have any questions or complaints about the informed consent process of this research study, please contact the Office of Research & Sponsored Programs (909) 869-3406.

This research study is attempting to measure if, when, and how your attitudes about doing arts and teaching arts change during the course of the Liberal Studies 420 class. All information gathered is confidential, and anonymous as far as you make it possible by using your code number on each questionnaire. Your participation is limited to this quarter, and your participation HAS NO EFFECT on your grade for the course. If you refuse to complete the questionnaires, your grade will not be affected.

The questionnaires will ask you to probe how you feel and what you think about different aspects of the arts, including your skills in doing them. We ask you to be honest and straightforward. It is not expected that your answers will be the same as or different from anyone else’s.

Data will be used to assess the effectiveness of this course and will influence how the course is changed in future quarters. If you would like to be informed of the conclusions drawn from this study, stay in touch with Dr. Riveire by email and she will share results with you as they become available.

Results of this research will be presented at scholarly meetings and may be prepared as an article for publication. No-one’s identity will be revealed in any article or presentation other than the teachers involved in the instruction.

If at any time you wish to withdraw from the study, and remove all previously completed questionnaires from the data bank, simply notify Dr. Riveire of that desire and reveal your code number. All data relating to that code number will be removed.

Thank-you.

If you give your consent to have your responses included in the research study, please sign your name, and print your name below the signature.

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