Project Title

Covitality from Counseling to the Classroom: A Psychometric Study of Covitality and Personal Effectiveness in Rural Maine Community College Graduates

Principal Investigator

Rebecca A. Martin, Doctoral student, The University of New England:


Please read this form. The purpose of this form is to provide you with information about this research study, and if you choose to participate, to document your decision.

You are encouraged to ask any questions about this study, now, during, or after the project is complete. You can take as much time as you need to decide whether you want to participate. Your participation is voluntary. Surveys will no longer be accessible after June 1st, 2018.

Why is this study being done?

This researcher is inviting adult students currently graduating from Kennebec Valley Community College (KVCC) to participate in research related to positive non-cognitive traits measurement. These traits, in combination, are measured by a term called covitality. A survey will be administered to identify the non-cognitive skills present in the graduating class. The survey is a combination of the Social Emotional Health Survey-Higher Education; and, the Review of Personal Effectiveness with Locus of Control. These instruments hope to identify the non-cognitive strengths present in the graduating class of 2018. I am attempting to identify these traits, as a way to assess the workforce readiness of graduating students. This form represents a process called: “informed consent,” and allows participants to be educated about the research in order to choose whether to take part in it.

As an adjunct faculty in the Mental Health program, and a community based psychotherapist, I am interested in the results on non-cognitive performance, as part of your education here, at Kennebec County Community College. You may already know the researcher as a teacher, counselor, or as a member of the KVCC community; however, this study is separate from those roles. I am completing this study as a doctoral student at The University of New England. The purpose of this study is to examine the relationship between the non-cognitive measures: the covitality questionnaire (SEHS-HE) and the personal effectiveness questionnaire (ROPELOC) in relation to student grade point average (GPA) upon graduation.
Who will be in this study?

Study participants will be selected based on eligibility for graduation, May 2018.  They shall be ages 18-65. All participation will be voluntary, with confirmation that involvement does not impact any course work or course outcomes. The surveys will arrive in institutional email, and graduating students will disclose their self-assessment answers to the combined questionnaires: the SEHS-HE and the ROPELOC. This will include a request for students to disclose their name, age, gender, and program. I will discard any incomplete surveys. I will use these surveys to better understand the non-cognitive measures you identify in relationship to the cognitive measure of grade point average (GPA).
Both an invitation to participate, and a consent to obtain this information from you, along with your consent to obtain your Grade Point Average from the college, is included in this email.

What will I be asked to do?

If you agree to be in this study, you will be asked to:

  1. Complete an online questionnaire. This should take no more than 20 minutes of your time. The survey identifies non-cognitive traits, one related to covitality and the other related to personal effectiveness. Links to this survey will be emailed to graduating students before graduation.
  2. After consent is given, students will provide the researcher with identifiable information, including Name, Program of study, Age and Gender, along with the answers to the survey questions.
  3. Completing these questionnaires gives consent to allow the researcher to collect Career GPA from the College. It also acknowledges this information will be stored for research purposes.

This study is completely voluntary.

There is no reward or punishment involved in participation, and involvement is at the discretion of each graduating student. The researcher is the only person that will have access to this combination of confidential information, and will collect and store this information with respect to protecting each student and following ethical standards.

It is absolutely the student’s choice regarding whether or not to participate in this study. No one at Kennebec Valley Community College will treat any participant differently based on this research.  If a student elects to join the study now, each student can change their mind and withdraw at any time. Information will be discarded as is reasonable to do, within this research. Participation in the study has no effect on any relationship within Kennebec Valley Community College, administration or with this researcher. 

What are the possible risks of taking part in this study?

The risks involved in your participation are minimal. Though revealing your name, program, and perceptions may carry some discomfort and vulnerability, and include time lost, being in this study will not pose risk to your safety, wellbeing, or academic standing. There are counseling services, free of charge, on campus, if any student wishes to discuss issues that may arise while completing these surveys. However, there are no foreseeable risks associated with participation in this study.

What are the possible benefits of taking part in this study?

Potential benefits of your participation include sharing your student experience by expressing your point-of-view, gaining insight into your non-cognitive skills, and providing a self-report of your experience as a student, here. 

What will it cost me?

Participation in this research study is free. The time and thoughtfulness required to complete the questionnaires is the only cost to you. There is no financial or academic benefit to participation. No payment or extra credit is extended.

How will my privacy be protected?

Any information you provide will be kept confidential. The researcher will not use your personal information for any purposes outside of this or related research projects. Student information will be de-identified once data is mined and stored, and will be stored with encryption and passwords, stored outside the community college setting, and will remain in this researchers possession until all research is complete. The data will be kept secure and will be purged and destroyed at the completion of the study.

How will my data be kept confidential?

This study will include shared details transmitted over the internet using firewall and encryption protections. Your confidential information will be collected and stored in a manner that protects your data.  Firewalls, encryption, passwords, and external hard drive storage off site, are some of the ways the electronic information will be protected. Additionally, this researcher uses standards of confidential practice when managing your data. Your identifiers will be coded in order to de-identify your information, and these pseudonyms will be used to track aggregate patterns.

This researcher will be the only person handling this combination of your information, and will safe guard it in accordance to research policies.
Institutional Research staff, at Kennebec Valley Community College, will provide respondent’s GPA scores, following graduation. Please note that regulatory agencies, and the Institutional Review Board may review the research records, excluding personal details. A copy of your signed consent form will be kept for three years after the project is complete before it is destroyed. The consent forms will be stored in a secure location controlled by this researcher.

No other institutional staff will have access to, or be affiliated with, any data obtained from you during this project.
Upon written request, any student may have a report of their own questionnaire results or a draft copy of findings. The University of New England, also, provides contacts with whom participants can speak to clarify rights as a participant or to seek general information regarding research guidelines.

The contact number for this research is: (207) 221-4962.

What are my rights as a research participant?

As a participant, your basic human rights are essential. Additionally, you have a right to confidentiality and privacy. Your participation is voluntary. Your decision to participate will have no impact on your current or future relations with the Kennebec County Community College or the University of New England. You may skip or refuse to answer any question for any reason. This will eliminate your questionnaires from data analysis.

What other options do I have?

You may choose not to participate.

Whom may I contact with questions?

The researcher conducting this study is Rebecca A. Martin. For questions or more information concerning this research you may contact her at or

If you choose to participate in this research study and believe you may have suffered a research related injury, please contact Mark Kavanaugh, at Kennebec County Community College, at or Carol Burbank, at The University of New England at

If you have any questions or concerns about your rights as a research subject, you may call Olgun Guvench, M.D. Ph.D., Chair of the UNE Institutional Review Board at (207) 221-4171 or

Will I receive a copy of this consent form?

You are free to print a copy of this document directly from the web.


The link below will take you to an online survey. The first page will ask you to review consent and agree to participate. You will not be able to take the survey without completing this section. The next page will provide you with a space for a digital signature, and ask you to initial and date your consent. This email includes an individual passcode that you will input here, as well, to access your survey.

Participant's Statement

I understand the above description of this research and the risks and benefits associated with my participation as a research subject.  I agree to take part in the research and do so voluntarily. My signature will be collected as part of the electronic survey.


Researcher’s Statement

The participant electronically signing and completing the survey had sufficient time to consider the information, had an opportunity to ask questions, and voluntarily agreed to be in this study.

Researcher’s signature Rebecca A. Martin                             Date 4/27/18
Printed name: Rebecca A. Martin