INFORMED CONSENT FORM

RE 5040, Fall, 2004

Appalachian State University

Professor Gary Moorman

Description of the Study

As one assignment in RE 5040, Fall, 2004, you will write an “Literacy Autobiography” which will be posted on the World Wide Web. These texts are in the public domain, and may be analyzed by Professor Moorman as part of a teacher research project. In the analysis and reporting of the research, pseudonyms will be used to protect your anonymity. Participation in this study is voluntary, and your refusal to participate will have no consequences on your course grade or in any other way. You may contact Professor Moorman (262‑6066) if you have any questions about the study or your consent.

Informed Consent

I understand that I am participating in a research project regarding the beliefs and instruction of classroom teachers. I further understand that I can refuse to participate, without consequence, at anytime during the study. This refusal ensures that my contributions will not be included in the final analysis of the autobiographies.

You will receive two copies of this form. Please sign and return one form, and keep the other for your records.

Your name (please print) ______________________________________

Your signature ______________________________________

Date _______________________

I understand the preceding information and AGREE to participate in the

study. _____

I understand the preceding information and DO NOT AGREE to participate in

the study. _____