Informed Consent for LASER Institute Module Survey

You are invited to participate in an evaluation of the LASER Institute modules. Please read this form carefully and ask any questions you have before agreeing to take part in the evaluation.

What the evaluation is about:
The LASER Institute has contracted with an independent firm, Hasse and Lovin Associates, LLC to conduct an evaluation of the program. As part of that evaluation, we are asking LASER Scholars to complete this survey. The survey will collect data on your experience with the LASER Institute content.

What you will be asked to do:
If you agree to participate, completing the survey should take 10 minutes or less.

What good will come of the evaluation:
Your views and opinions will provide information to help the LASER Institute improve in the future.

Important Things to Know about Being Part of the Evaluation

1. You don’t have to do this. Participation is completely voluntary and you can stop at any time.

2. Risks to you. As in any program evaluation, participants could conceivably experience discomfort or uncertainty relating to topics or questions raised. This, however, is no larger a risk than any routine online or personal discussion you would encounter in your daily professional life and therefore does not represent any risk particular or unique to this project.

3. Data Confidentiality. Your responses and any information you provide will be kept completely confidential. Your name will not be connected to your individual responses. Information provided by you in response to this survey will be linked to an identification (ID) number known only to Hasse and Lovin Associates staff. Once your information is coded with the unique ID, your personal name, and any other personally identifiable information about you will not be associated with any data file containing your responses. Data will be reported in aggregate. Although quotes from open ended items may be included in reports, identifying information such as organization names will be removed. Deidentified data from the survey will be shared with the LASER Institute. Hasse and Lovin staff will analyze the data to create evaluation reports. Only evaluation reports, not raw data, will be shared with the LASER Institute. The LASER Institute will control any further dissemination of evaluation reports.

4. Questions. If you have questions at any time about the evaluation or the procedures, you may contact Pamela Lovin, Director of Evaluation at Hasse and Lovin Associates at the following email address: (pamela@hasselovin.com).

You are welcome to print a copy of this page for your records.
General Data Protection Regulation For Participants in the European Union and United Kingdom

If you are in the European Economic Area (EEA), the General Data Protection Regulation (GDPR) is a European law that details conditions under which it is lawful to collect, use, disclose or process personal data. For this evaluation project, the data being collected is information on your experience at the summer workshop and how you plan to use the content from the LASER Institute this year. Hasse and Lovin Associates, LLC located in Wake County, North Carolina has been contracted by the LASER Institute to collect this data via a survey instrument. The platform for survey administration is Survey Monkey, which provides a Data Processing Agreement including the most recent EU and UK approved Standard Contractual Clauses/Model Clauses referred to in the EU GDPR and the UK GDPR for all customers.

The reason this data is being collected is to allow the LASER Institute to judge the merit of the program and its replicability, and to identify opportunities for continuous improvement. Data collected in this survey will be de-identified before analysis. Data will be reported in aggregate. Evaluation reports and deidentified data files, will be shared with the LASER Institute. Data files will be securely stored for 3 years after completion of the LASER Institute in accordance with Hasse and Lovin data retention practices. Although quotes from open-ended items may be included in reports, identifying information such as department names will be removed from the quote before including it in any report. Participation in this survey is completely voluntary and is not a requirement of participation in the LASER Institute. The use of your information is unlikely to cause harm to you.

You can contact Pamela Lovin, Director of Evaluation/Co-President, Hasse and Lovin Associates with any questions or concerns or to withdraw your data from the evaluation within 3 days of submitting your survey or interview via the following email: pamela@hasselovin.com.

One lawful basis for collecting and storing this data is your consent, which you may indicate by checking the box below.

Question Title

* 1. * Statement of Consent: Please indicate your willingness to participate in this survey.

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