WASHINGTON STATE UNIVERSITY

Educational Leadership and Counseling Psychology

Research Study Consent Form
Study Tite! To the Extent Feasible: Social Justice Principals Perspectives on
Students with Alcohol, Tobacco and Other Dru !ssues
Researchers! Principal Investigator: "ichele Ac#er$%ocevar, Ph&D&, Associate
Pro'essor, (ashinton State )niversit* Tri$+ities, Educational
,eadership and +ounselin Ps*cholo* Depart-ent, ./01 +ri-son
Drive, 2ichland, (A 33456& E-ail ac#erhoc7tricit*&wsu&edu8
telephone 513$4/.$/.50
Co-investigator: Daniel J& 9issonnette, Ed&D& :+andidate;& E-ail
daniel&bissonnette7e-ail&wsu&edu8 telephone .54$..5$.0/5
<ou are bein as#ed to ta#e part in a research stud* carried out b* Dr& "ichele Ac#er$
%ocevar and Dan 9issonnette& This 'or- explains the research stud* and *our part in it
i' *ou decide to =oin the stud*& Please read the 'or- care'ull*, ta#in as -uch ti-e as
*ou need& As# the researcher to explain an*thin *ou dont understand& <ou can decide
not to =oin the stud*& !' *ou =oin the stud*, *ou can chane *our -ind later or >uit at an*
ti-e& There will be no penalt* or loss o' services or bene'its i' *ou decide to not ta#e
part in the stud* or >uit later& This stud* has been approved 'or hu-an sub=ect
participation b* the (ashinton State )niversit* !nstitutional 2eview 9oard&
What is this study a"out#
This research stud* is bein done to explore the role o' principals in their wor# with
students who are i-pacted b* alcohol, tobacco, and other dru issues&
<ou are bein as#ed to ta#e part because *ou have been reconi?ed as bein a social
=ustice leader who de-onstrates co-passion and e-path* 'or students i-pacted b*
alcohol, tobacco, and other drus&
Ta#in part in the stud* will ta#e about 6 hours over two interview sessions in the
-onths o' Jul* throuh Septe-ber .10.& Follow up discussions 'or clari'ication -a* be
re>uested&
<ou cannot ta#e part in this stud* i' *ou do not possess a principal or ad-inistrator
credential, or have not been e-plo*ed in a position o' principal, assistant principal, or
director in the role o' principal8 or i' *ou do not aree to havin *our interviews diitall*
recorded&
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Version: February 2008
What $i I "e as%ed to do i& I am in this study#
!' *ou ta#e part in the stud*, *ou will be as#ed to
Participate in two (2) private, confidential interviews in a setting of your choosing
Prior to any interview, you will !e as"ed to co#plete a written Participant
$e#ographics for# that includes !asic personal infor#ation such as na#e, age,
race, gender, degree(s) and credential(s), and e%perience as an educator,
&he first interview will !e #ore for#al according to a pre-esta!lished interview
protocol
&he second interview will !e open-ended, #ore of a guided conversation
&he first interview will ta"e place in 'uly()ugust, 2*+2
&he second interview will ta"e place in )ugust(,epte#!er, 2*+2
Each interview will ta"e appro%i#ately +- to 2 hours to co#plete for a total of up
to . hours
&he protocol for the first interview includes /uestions that are of a personal and
sensitive nature including: i#pressions of yourself as a social 0ustice leader1
type, a#ount, and fre/uency of your use of alcohol, to!acco, or other drugs, and
e%perience you #ay have had in your life relating to alcoholis# or addictions1
use of co#passion and e#pathy in your wor" with at-ris" students1 your
leadership actions1 and !arriers and resistance you #ay face in your wor" as a
social 0ustice leader ,o#e real-life scenarios are as"ed to gain insights a!out
your approach to circu#stances
&he /uestions for the second interview will !e developed as a result of the first
interview
2ou #ay refuse to answer any /uestion in either interview
2ou will !e as"ed to provide supporting docu#entation of your choosing that you
thin" are representative of your wor" as a social 0ustice leader, ie, #e#ora!ilia,
#e#oranda, policy(procedure, agendas, #inutes
Interviews will !e digitally recorded

) description of the results of the first interview and transcriptions will !e shared
with you at the ti#e of the second interview
,u##ary results of the study will !e shared with you in a #anner agreed upon at
the ti#e of the second interview, including possi!le follow up discussion, and
sharing of the of the study report
Are there any "ene&its to me i& I am in this study#
The potential bene'its to *ou 'or ta#in part in this stud* are: There is no direct bene'it to
*ou 'ro- bein in this stud*&
If you ta"e part in this study, you #ay help others in the future !y contri!uting your
values, !eliefs and perspectives as a social 0ustice principal wor"ing with students with
alcohol, to!acco, and other drug issues
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Are there any ris%s to me i& I am in this study#
The potential ris#s 'ro- ta#in part in this stud* are:
Psychological, econo#ic, social, e#ploy#ent, reputation, or loss of confidentiality
or sensitive infor#ation
3is"s associated with sensitive /uestions, for e%a#ple, distress or disco#fort
Precautions will !e ta"en to #ini#i4e ris"s including:
$ata is o!tained !y a trained and e%perienced interviewer who is aware of the
nature of sensitive personal infor#ation and the act of sharing such infor#ation
with another person
Interviewer is s"illed in laws and practices related to confidentiality and the
"eeping and destroying of confidential records
Wi my in&ormation "e %e't 'ri(ate#
The data 'or this stud* will be #ept con'idential to the extent allowed b* 'ederal and state
law& @o published results will identi'* *ou, and *our na-e will not be associated with the
'indins& )nder certain circu-stances, in'or-ation that identi'ies *ou -a* be released
'or internal and external reviews o' this pro=ect&
$ata is o!tained in private interview sessions !etween interviewer and
participant only 5o identifying infor#ation will !e shared with other participants
Participant identity will !e protected, ensuring confidentiality1 each participant will
!e given a pseudony#
)ll identifying infor#ation shared in interview will !e protected1 participant
na#es, addresses, and schools will not !e divulged
)ge, gender, and race will !e identified only in the aggregate
6hile the study is ongoing, digital recordings will stored on researcher7s
co#puter hard drive with password protection, and on universal serial !us (8,9)
flash drive )t the conclusion of the study, digital records will !e re#oved fro#
hard drive to flash drive for per#anent "eeping
)ll records including digital recordings on flash drive, transcriptions, artifact
docu#ents, and field notes will !e "ept in researcher7s possession under loc"
and "ey
In the event any infor#ation is co#pro#ised, affected study participants will !e
infor#ed In such a case, every reasona!le effort would !e underta"en to
retrieve and "eep safe all records
:nly researchers and the Institutional 3eview 9oard (I39) will have access to
personally identifying infor#ation
$igital recordings will !e #ade of participants during interviews, as a re/uire#ent to !e
in the study
The results o' this stud* -a* be published or presented at pro'essional -eetins, but
the identities o' all research participants will re-ain anon*-ous
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The data 'or this stud* will be #ept 'or a -ini-u- o' three :4; *ears a'ter the co-pletion
o' the stud* as re>uired b* (ashinton State )niversit*&
Are there any costs or 'ayments &or "ein) in this study#
There will be no costs to *ou 'or ta#in part in this stud*&
<ou will not receive -one* or an* other 'or- o' co-pensation 'or ta#in part in this
stud*&
Who can I ta% to i& I ha(e *uestions#
!' *ou have >uestions about this stud* or the in'or-ation in this 'or-, please contact
either o' the researchers: Principal Investigator: "ichele Ac#er$%ocevar, Ph&D&,
Associate Pro'essor, (ashinton State )niversit*, Tri$+ities, Educational ,eadership
and +ounselin Ps*cholo* Depart-ent, ./01 +ri-son Drive, 2ichland, (A 334568
e-ail ac#erhoc7tricit*&wsu&edu8 or telephone 513$4/.$/.508 andAor Co-investigator:
Daniel J& 9issonnette, Ed&D& :+andidate;8 e-ail daniel&bissonnette7e-ail&wsu&edu8 or
telephone .54$..5$.0/5
!' *ou have >uestions about *our rihts as a research participant, or would li#e to report
a concern or co-plaint about this stud*, please contact the (ashinton State )niversit*
!nstitutional 2eview 9oard at :513; 445$4BBC, or e$-ail irb7wsu&edu, or reular -ail at:
Albroo# .15, PO 9ox B64115, Pull-an, (A 330B6$4115&
What are my ri)hts as a research study (ounteer#
<our participation in this research stud* is co-pletel* voluntar*& <ou -a* choose not to
be a part o' this stud*& There will be no penalt* to *ou i' *ou choose not to ta#e part&
<ou -a* choose not to answer speci'ic >uestions or to stop participatin at an* ti-e&
What does my si)nature on this consent &orm mean#
<our sinature on this 'or- -eans that:
<ou understand the in'or-ation iven to *ou in this 'or-
<ou have been able to as# the researcher >uestions and state an* concerns
The researcher has responded to *our >uestions and concerns
<ou believe *ou understand the research stud* and the potential bene'its and
ris#s that are involved&
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Statement o& Consent
! ive -* voluntar* consent to ta#e part in this stud*& ! will be iven a cop* o' this
consent docu-ent 'or -* records&
DDDDDDDD ! a- aware o', and consent to, the diital recordin o' -* interviews&
:!nitials;
DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD DDDDDDDDDDDDDDDDDDDDD
Sinature o' Participant Date
DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD
Printed @a-e o' Participant
Statement o& +erson O"tainin) In&ormed Consent
! have care'ull* explained to the person ta#in part in the stud* what he or she can
expect&
! certi'* that when this person sins this 'or-, to the best o' -* #nowlede, he or she
understands the purpose, procedures, potential bene'its, and potential ris#s o'
participation&
! also certi'* that he or she:
Spea#s the lanuae used to explain this research
2eads well enouh to understand this 'or- or, i' not, this person is able to hear
and understand when the 'or- is read to hi- or her
Does not have an* proble-s that could -a#e it hard to understand what it -eans
to ta#e part in this research&
DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD DDDDDDDDDDDDDDDDDDDDDDDDD
Sinature o' Person Obtainin +onsent Date
DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD DDDDDDDDDDDDDDDDDDDDDDDDD
Printed @a-e o' Person Obtainin +onsent 2ole in the 2esearch Stud*
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