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Parental Informed Consent for the Medford High School Similarity Study


October 3, 2014

Dear Parent/Guardian,

Dr. Perella, Headmaster at Medford High School, and researchers from the Harvard Graduate School of
Education are conducting a study to learn more about how we might help MHS faculty and students
improve the learning experience for both parties. We would like to invite your child to participate in this
study. We developed this study to better understand counselors-students relationships and the factors that
influence them. The results from this study will help Medford High School develop programs that address
the academic and social needs of its diverse student body.

Participation is voluntary
Your participation is voluntary. Students can decide whether they want to participate. There is no penalty
for not participating. Even if they start the questionnaire, they can decide to not answer any question or quit
in the middle. Refusal to participate or stopping your participation will involve no penalty or loss of
benefits to which you or your child are otherwise entitled.

What is the purpose of this research?
The purpose of this research is to better understand counselor-student relationships and the factors that
influence them.

How long will my child take part in this research?
Your childs participation will take approximately 40 minutes of total time spread out over a couple
separate occasions. This study will continue through J une 2015.

What can I expect if my child takes part in this research?
To avoid interrupting course instructional time, students will complete a questionnaire during an advisory
period in October. The questionnaire will take about 25 minutes for most students to complete, and
students will answer a series of get to know you questions, such as what they like to do in their free time,
what traits they would use to describe themselves, etc. They then may be provided with feedback about
their responses to the survey and they will be asked for some brief reactions to this feedback. They will also
be asked to fill out an exit ticket after meeting with their counselors so that students can assess how
helpful the counselors were and how useful the meeting was. Student records such as performance data,
attendance data, counselor appointment data, and demographics will be shared with the research team to
look at the factors that influence counselor-student relationships.

What are the risks and possible discomforts?
The risks of participating in this study are minimal. There is a minimal risk to confidentiality, but the
upmost precautions are being taken to ensure data security.

Are there any benefits from being in this research study?
There are some benefits to participating in research like this. The data will be used to inform the field of
educational and development research on ways to improve the academic and social outcomes of students

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from diverse backgrounds. If you wish, you can send an email message to Hunter Gehlbach at
Hunter_Gehlbach@gse.harvard.edu and we will send you a copy of any articles based on the research.
There is no compensation for participation.

How will my childs privacy be protected? What happens to the information you
collect?
The first get to know you questionnaire is not confidential the whole point of the survey is to help
counselors and students get to know each other better. However, all following information your child
gives us will be kept confidential. In other words, no administration, faculty, or other students will have
access to these responses. Only the research team will be able to link students questionnaire responses
to their school records. After the questionnaire is completed and the responses matched to your
adolescents school records, a number will be assigned to his/her information and all names will be
removed. No one at your childs school will be able to find out exactly what any individual student said.
We will report back information to the Medford community only as averages and trends. The school will
provide a copy of the records disclosed upon request.

Who can I talk to with questions, concerns or complaints about this research?
The researcher for this study is Hunter Gehlbach who can be reached at hunter_gehlbach@harvard.edu;
13 Appian Way, Cambridge, MA 02476; 617-496-7318.

This research has been reviewed by the Committee on the Use of Human Subjects in Research at
Harvard University. They can be reached at 617-496-2847, 1414 Massachusetts Avenue, Second Floor,
Cambridge, MA 02138, or cuhs@fas.harvard.edu.

You do not have to do anything unless you do not want your child to participate. If you do not want youre
your child to participate, please sign and return this form to the front desk by Friday, October 10
th
or
contact Hunter Gehlbach, principal investigator, at hunter_gehlbach@gse.harvard.edu. Research
administrators will otherwise assume that parents consent to their child participating.



PLEASE RETURN only if you DO NOT want your child to participate


Students Name (please print) _________________________ Grade: __________________

I have read this letter about the Medford High School Similarity Study and do not want my child to
take part in this project.

________________________________ _______________________________
Parents Name (please print) Parents Signature

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