2017 Mitochondrial Biochemistry, Genetics and Molecular Biology Workshop Application

Part 1: Certifications

Thank you for your interest in the cCWCS workshop series. The National Science Foundation is interested in the impact of the programs that it sponsors.  By clicking the link to continue at the bottom of the page, you indicate your consent to be in the evaluation study described below.


Georgia Institute of Technology
Project Title:
cCWCS Faculty Data Collection
Investigators: David Collard, Cianán Russell
Protocol and Consent Title: 11/13 v1

You are being asked to be a volunteer for a research study.

Purpose: The purpose of the study is to investigate the effects of the Chemistry Collaborations, Workshops and Communities of Scholars (cCWCS) Program. You are invited to participate because you are applying to be a participant in one of these workshops. We expect up to 2,000 people to participate in this study.

Procedures: If you decide to be in this study, you will complete the questionnaire on the upcoming pages to the best of your abilities, as well as three more similar questionnaires if you are chosen to participate in the workshop – one immediately following the workshop, one approximately 18-24 months after the workshop ends, and one approximately 56-60 months after the workshop ends. Participation will require approximately 20-30 minutes of your time in each session.

Risks or Discomforts: The risks involved are no greater than those involved in daily activities such as reading the newspaper and chatting online or reading and writing email.

Benefits: You are not likely to directly benefit in any way from joining this study. We hope that what we learn will help improve the instruction provided at the cCWCS workshops and assist in making the workshops more impactful for the participants.

Confidentiality: The following procedures will be followed to keep your personal information confidential in this study: The data collected about you will be kept private to the extent allowed by law. To protect your privacy, your records will be kept under a code number rather than by name; a file linking the code with your name and identity will exist on the evaluator’s computer and will be destroyed at the end of data collection. Your records will be kept in locked files and only the evaluator will be allowed to look at them. Your name and any other fact that might point to you will not appear when results of this study are presented or published. Your privacy will be protected to the extent allowed by law. To make sure that this research is being carried out in the proper way, the Georgia Institute of Technology IRB may review study records. The Office of Human Research Protections may also look over study records during required reviews. You should be aware that the experiment is not being run from a ‘secure’ https server of the kind typically used to handle credit card transactions, so there is a small possibility that responses could be viewed by unauthorized third parties such as computer hackers. In general, the web page software will log as header lines the IP address of the machine you use to access this page (e.g.102.403.506.807), but otherwise no other information will be stored unless you explicitly enter it.

Compensation: You will not be compensated for participating in this study.

Costs to You: There are no costs to you, other than your time, for being in this study.

In Case of Injury/Harm: If you are injured as a result of being in this study, please contact Dr. David Collard at {404}607-7027. Neither the Principal Investigator nor Georgia Institute of Technology has made provision for payment of costs associated with any injury resulting from participation in this study.

Participant Rights: Your participation in this study is voluntary. You do not have to be in this study if you don't want to be. You have the right to change your mind and leave the study at any time without giving any reason and without penalty. Any new information that may make you change your mind about being in this study will be given to you. You may print a copy of this consent form to keep at this time. You do not waive any of your legal rights by continuing with the study and accepting the terms of this consent form.


By clicking the button below to continue to the rest of the appliation, you indicate your consent to be in the study.