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Informed Consent for Baseline Survey

Advancing Women in Science and Engineering in the University of Wisconsin System

Dr. Erin Winterrowd of the Department of Psychology at the University of Wisconsin Oshkosh is conducting a study of the effectiveness of a mentoring program for female senior faculty in Science, Technology, Engineering and Math (STEM) fields. Your participation in this study would be greatly appreciated and will assist in making recommendations regarding training and mentoring of women in these fields.

As part of this study, please fill out the Baseline Survey for Horizontal Mentoring. There are questions related to your current mentoring experiences and professional goals. Additionally, you will be asked to evaluate the mentoring program again following its completion. Please not that this study is voluntary and not required to participate in the UW Women and Science Mentoring Program. Although this question could be studied by just observing your participation in the program, asking you directly about your knowledge and experiences will provide more accurate information.

There are no anticipated risks to your participation in this study, other than the inconvenience of extra time required for you to answer the questionnaire. Participation in this study may not benefit you directly. The information you provide in the questionnaire will be recorded in anonymous form. Information about you will not be released to anyone or in a way that could identify you.

If you want to withdraw from the study at any time, you may do so without penalty. The information collected from you up to that point would be destroyed if you so desire. Once the study is completed, the results will be available to you. In the meantime, if you have any questions, please ask or contact:

Dr. Erin Winterrowd
Department of Psychology
UW Oshkosh
Oshkosh, WI 54901
(920)424-7175

If you have any concerns about your treatment as a participant in this study, please call or write:

Chair, Institutional Review Board For Protection of Human Participants
c/o Grants Office
UW Oshkosh
Oshkosh, WI 54901
(920) 424-1415

Although the chairperson may ask for your name, all complaints are kept in confidences.

I have received an explanation of the study and agree to participate. I understand that my participation in this study is strictly voluntary.