Consent Section

Governors State University
College of Health and Human Sciences
Communication Disorders

Title of Research Study: School-based Dysphagia Management Survey

Principal Investigator:
Dr. Danielle Osmelak, EdD, CCC-SLP
Key Information:

The following is a short summary of this study to help you decide whether to participate or not. More detailed information is listed later on in this consent form.

  • Your consent to participate in this study is being sought through a description of activities in this form. Participation in this study is voluntary and you can choose not to participate or withdraw at any time without any penalty.
  • The purpose of this study is to assess school-based speech-language pathologist caseload demographics and school-based dysphagia practice patterns.
  • You will be asked to answer brief questions via this online survey related to dysphagia practice patterns. 
  • We expect that your participation in this study will take up to ten minutes.
  • The risks of participating are minimal. The benefits of the study are contributing to the body of knowledge about school-based dysphagia management.
Why am I being asked to participate in this research study?

We are asking you to participate in this research study because you are a school-based speech-language pathologist and the current study is exploring school-based dysphagia practice patterns.

What should I know about participating in a research study?

  • Whether or not you participate is up to you. You can choose not to participate.
  • You can agree to participate and then later change your mind.
  • Your decision will not be held against you or result in penalty.
What happens if I agree to participate in the research study?

If you agree to participate in this research study, you will be asked to answer 25 questions in total related to your experiences as a speech-language pathologist and your practice patterns related to dysphagia within a school-based setting.

Is there any way being in this study could be bad for me?

The risks of participating in this study are minimal and will not affect the participant’s daily life.

What happens if I do not want to be in this research?

Participation in research is voluntary. You can decide to participate or not to participate.

What happens if I say “Yes”, but I change my mind later?

You can leave the research study at any time and it will not be held against you. If you withdrawal during the online survey, incomplete surveys will be omitted from the research findings.

What happens to the information collected for the research?

Participants' answers will remain confidential, anonymous, and contain no identifying information. Only the researcher and the dissertation supervisor will have access to data. Collected data will be kept locked and destroyed three years after completion of the study. Participants' identifiable information will not be asked within the survey and study. 
Data Sharing

Results from this study (without any of your personal information) may be shared with other researchers to advance science and health. We will remove or code any personal information that could identify you before files are shared with other researchers to ensure that, to the best of our knowledge, no one will be able to identify you from the information we share. Despite these precautions, there is always the remote risk that there could be a breach of confidentiality, but we will do our best to avoid that risk.
Who can I talk to?

If you have questions, concerns, or complaints talk to the Principal Investigator Dr. Danielle Osmelak at or by phone at (708) 235-7532  and Elizabeth Brennan, graduate student, at

This research has been reviewed and approved by an Institutional Review Board (“IRB”); IRB#: IRB-FY2019-128. You may contact the IRB Co-Chairs (Darrin Aase and Renee Theiss) at if you have questions or concerns regarding your rights as a research participant. You may also contact the Director of Sponsored Programs and Research at (708) 235-2846.

If you want a copy of this consent for your records, you can print it from the screen.

Question Title

* If you wish to participate, please click the “I Agree” button and you will be taken to the survey.

If you do not wish to participate in this study, please select “I Disagree” or select X in the corner of your browser.