University Supervisor Evaluation

of Mentor Teacher/Classroom Teacher Educator and Office of Field Services

Consent Form

Dear University Supervisor:

In an attempt to ensure the most educative field services possible, the Office of Field Services at Cleveland State University would like you to complete a 20-minute, online survey to help us evaluate the mentors with whom you worked and the Office of Field Services. We are conducting this study as part of our ongoing teacher preparation program improvement efforts. Therefore, we would like your opinions regarding the quality of your experiences with the mentors of our interns and the Office of Field Services.

There are no serious risks in participating in this study. The information you provide will be held in confidence. The data will be collected on a secure website and saved separately from this consent form to protect your identity. The Office of Field Services will retrieve this data after the grades for the semester have already been reviewed and submitted. Your responses will become part of aggregated feedback that will be provided to university supervisors and the Office of Field Services, after the semester has ended.

Please be assured that your participation is voluntary. You may refuse to participate or may discontinue the survey at any time. There is no specific reward for participating in this study, but the survey provides you with an opportunity to help us improve the teacher education program.

Please contact Dr. Brian Yusko (216-875-9774, b.yusko@csuohio.edu) or Andrea Moss at (440- 461-9365, AttyDree@aol.com) if you have any questions regarding this study. This project has been reviewed and has received ethics clearance through the Internal Review Board at Cleveland State University.

By typing your name in the box below, you indicate that you are signing this form, thus providing informed consent. Moreover, you understand that if you have any questions about your rights as a research participant you can contact the CSU Institutional Review Board at (216) 687-3630.

Please retain a copy of this form for your records. Thank you for your cooperation and support.

Supervisor Name

survey software