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Informed Consent Agreement


Please read this consent agreement carefully before you decide to participate in the study.

Purpose of the research study: The purpose of this study is to examine the impact involvement with a program or community has on the student experience.

What you will do in the study: Participants will complete a survey regarding a particular aspect of their college experience.

Time required: The study will require about 15 minutes of your time.

Risks: There are no anticipated risks in this study.

Benefits: There are no direct benefits to you for participating in this research study. The study may help us understand the benefits of specific programs and communities to the undergraduate experience.

Confidentiality: The information that you give in the study will be anonymous. Your name or other identifying information will not be collected or linked to these data.

Voluntary participation: Your participation in the study is completely voluntary.

Right to withdraw from the study: You have the right to withdraw from the study at any time without penalty.

How to withdraw from the study: If you want to withdraw from the study, stop the survey and do not submit your responses. There is no penalty for withdrawing. Because data is anonymous it will not be possible to withdraw after your materials have been submitted.

Payment: You will receive no payment for participating in the study

If you have questions about the study, contact:

Christian L. Steinmetz, Ph.D.
Curry School of Education, EDLF – Higher Education
University of Virginia, Charlottesville, VA 22903.
Telephone: (434) 924-3180
Email address: [email protected]

If you have questions about your rights in the study, contact:

Tonya R. Moon, Ph.D.
Chair, Institutional Review Board for the Social and Behavioral Sciences
One Morton Dr Suite 500
University of Virginia, P.O. Box 800392
Charlottesville, VA 22908-0392
Telephone: (434) 924-5999
Email: [email protected]
Website: www.virginia.edu/vpr/irb/sbs

Agreement: Completion and submission of this survey indicates consent to participate.
 
 
 
 
* What race or ethnicity do you identify with? Please choose as many options that apply to you.
 
American Indian or Alaskan Native
 
African American
 
Asian
 
Hispanic
 
Native Hawaiian or Pacific Islander
 
White
 
Multi-race
 
I choose not to identify
 
Other
 

 
 
 
* What forms of government assistance have you or your family received within the past 12 months? Please choose all that apply to you.
 
TANF (Temporary Assistance for Needy Families)
 
SNAP (formerly known as Food Stamps)
 
Medicaid
 
Unemployment Insurance
 
Neither I nor my family has received government assistance in the past 12 months.
 
Other (please explain)
 

 
 
 
* Did you fill out the FAFSA or have someone fill it out on your behalf?
 
No
 
Yes
 
 
 
* Did you receive the Pell Grant or were you eligible for the Pell Grant this school year?
 
No
 
Yes
 
 
 
* Please rank (1-6) the following reasons for attending UVa in order of importance:
1 = most important
6 = least important
Family influence
Financial aid package
Extracurricular activities
Cost of attendance
Location of college/university
Reputation of college/university
 
 
Which of the following factors were important to you in determining which college you ultimately attended? Please rate each option based on your feelings.
Not at all important Somewhat important Very important Critically important N/A
* College's reputation
* College is in-state
* Amount of grants or scholarships received
* College's total tuition costs (including fees)
* A friend attends or attended the college
* College is known for your program of interest
* College has a diverse student population
* College is close to home (< 100 miles)
* College was recommended by a counselor
* Amount of work study received
Not at all important Somewhat important Very important Critically important N/A
* College's room and board costs
* Outreach efforts performed by the college
* Your SAT score
* Your family's financial situation
* Parent or family influence
* Amount college spends per student
* College is a public institution
* Amount of loans received
* College is a private institution
* Your ACT score
* College is out-of-state
* Parent or family member attended the college
* Selectivity of the college
* College is far from home (> 100 miles)
* College's athletic division
 
 
 
* Did you receive any of the following types of financial aid? Please select as many that apply to you.

 
 
 
* Do you commute to school?
 
 
 
* What is your current living situation?
 
Living on-Grounds
 
Living in a fraternity or sorority house
 
Renting an apartment or house near campus
 
Living at home with family
 
Other (please specify)
 
 
 
 
* How many colleges did you apply to?
 
1
 
2-3
 
4-5
 
6-7
 
8 or more
 
 
 
* How many colleges were you accepted to?
 
1
 
2-3
 
4-5
 
6-7
 
8 or more
 
 
 
* Are you currently attending your first choice college?
 
Yes, attending 1st choice
 
No, attending 2nd choice
 
No, attending 3rd choice
 
No, attending lower than 3rd choice
 
Only applied to 1 college
 
 
 
* Did you attend another college or university before this one?
 
 
 
* If you could do it again, would you still enroll at your current institution?
 
Definitely no
 
Probably no
 
Unsure
 
Probably yes
 
Definitely yes
 
 
 
* What is your enrollment status?
 
 
 
* What is your academic year?
 
 
 
* What is your intended major?
   
 
 
 
* What is your GPA?
   
 
 
 
* What is your mother's highest level of education?
 
 
 
* What is your father's highest level of education?
 
 
 
* What gender do you identify with?
 
Male
 
Female
 
I choose not to identify
 
Other (please specify)
 
 
 
 
* How old are you?
   
 
 
 
If you would like to be entered into the random drawing for the $25 or $75 VISA Gift Cards, please put your computing ID in the box below (ex. UVA2T). Your responses on this survey will not be associated with your computing ID. This ID will only be used to select and notify the recipients on the gift cards.
   
 
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