APPENDIX F: Student Participation Consent Form
CONSENT FORM
THE EFFECT OF GROUP COUNSELING INTERVENTION ON THE PERFORMANCE OF RURAL
STUDENTS ON THE GEORGIA HIGH SCHOOL GRADUATION TESTS OR END-OF-COURSE TESTS
Donna A. Caudell
Liberty University
Department of Education
You are invited to be in a research study to determine if participating in the group guidance portion of the Student
Success Skills program helps students pass the Georgia High School Graduation Test. You were selected as a
possible participant because you still have one or more Georgia High School Graduation Tests to successfully
complete. We ask that you read this form and ask any questions you may have before agreeing to be in the study.
This study is being conducted by Donna A. Caudell, Liberty University Department of Education.
Background Information:
The purpose of this study is to determine if the 8-week guidance portion of the Student Success Skills program could
statistically impact the Georgia High School Graduation Test scores of students who had previously failed at least
one portion of the Georgia High School Graduation Test.
Procedures:
If you agree to participate in this study, we would ask you to do the following things:
1. Attend eight 45-minute group guidance sessions, conducted by Mrs. Caudell (Sophomore Counselor).
These sessions will be scheduled before, during, or after school, depending on what works best with all
group members’ schedules.
2. Listen and treat all other group members with respect.
3. Complete the goals you set for yourself at each group guidance session before the next session.
4. Take the Georgia High School Graduation Test that you still need to pass during the spring 2013
administration of the tests.
5. Maintain confidentiality of everything done and discussed during the group guidance sessions. While the
information discussed in these group sessions will be academic and social in nature, no on will be asked to
discuss information that is too personal or private to them. Respect for others, however, indicates that all
things discussed in these group guidance sessions are considered confidential and should not be discussed
with anyone outside of the group. There will be no audio or video taping of these group sessions.
Risks and Benefits of participating in the Study:
There are no risks involved in participating in this study that are greater than you face in your everyday school life.
The study has several risks:
1. Participation in this study does not guarantee that you will pass your Georgia High School Graduation Test.
2. If the meeting time of the group guidance session causes you to miss time from a class (no more than 45
minutes), you will be responsible to make up any work missed and may have to do that after school hours.
3. If you disclose information to the group or to Mrs. Caudell that indicates that you are being abused or
harmed in any way, that you pose a risk of harming yourself in any way, or that you intend to harm
someone else in any manner, Mrs. Caudell (as a mandated reporter) will be required to report this
information to the proper agency or authority. Mrs. Caudell will discuss her concerns with you and will not
make a report without your knowledge.