OMB Control Number XXXX - XXXX (Exp XX/XX)

REL Midwest Ramp - Up to Readiness Staff Consent Form 20 East Diehl Road, Suite 200 | Naperville, IL 60563 - 1486 | P: 866 .730.6735 F: 630 . 649 . 6700 www.relmidwest.org 

### Staff Consent Form **Purpose** Our school has partnered with the Regional Educational L aboratory (REL) Midwest to study the implementation of a schoolwide guidance program called Ramp - Up to Readiness (“Ramp - Up”) developed b y the College Readiness Consortium at the University of Minnesota. RELMidwest, operated b y Ameri can Institutes for Research, is sponsored by the Institute of Education Sciences (IES) at the U.S. Department of Education. The evaluation will examine how school staff implement Ramp - Up and how the intervention compares with college - readiness supports in other high schools. The stud y has been submitted to IES for research approval. The data collection activities have also been approved b y the U. S. Office of Management and Budget. RELMidwest invit es yo u to complete the following online survey . **Voluntary Participation**  Participation in all data collection activities is voluntary . You also can withdraw from the study at an y time. Individuals who decline to participate or later withdraw from the study will face no personal or professional repercussions. **Risks** There are few anticipated or known risks in participating in this study . Data collected and maintained by , or under the auspices of , IES under a pledge of confidentiality shall be treated in a manner that will en sure that individually identifiable data will be used only for statistical purposes and will be accessible only to authorized persons. According to the Paperwork Red uction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is XXXX.XXXX, OMB expiration date is XXXX, XX, 2014. The time required to complete this information collection (consent form) is estimated to average 5 minutes per respondent, including the time to review instructions, gather the data needed, and complete and review the information collected. Participation in this d ata collection task is voluntary. Per the policies and procedures required by the Education Sciences Reform Act of 2002, Title I, Part E, Section 183, response s to this data collection will be used only for statistical purposes. The reports prepared for this study will summarize findings across the sample and will not associate responses with a specific school, district, or individual. Any willful disclosure of such information for nonstatis tical purposes, except as required by law, is a class E felony. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to : U.S. Department of Education, Washington, DC 20202. If you have comments or concerns regarding the status of your individual submission of this form, write directly to: U.S. Department of Education, Institute of Education Sciences, 555 New Jersey Avenue, NW, Washington, DC 20208.**Benefits**

Your participation in the evaluation will contribute to an understanding of a schoolwide college readiness program that seeks to improve the college readiness outcomes of all students. You will also receive a $25 gift card from Amazon.com for participating in the data collection activities. **Confidentiality** Your responses will not be connected to your personally identifiable information. Responses to this data collection will be used onl y for statistical purposes. The reports prepared for this study will summarize findings across the sample and will not associate responses with any specific individual. The researchers will not provide information that identifies you or y our school to any one outside the study

team, except as required by law. **More Information** If you would like more information about this study, you may contact Jim Lindsay of REL Midwest at 630 - 649 - 6591. **Informed Consent** By signing this form , yo u are indicating that you have read and understood the information provided to y ou about y our participation. Yes, I want to participate in this study . Yes, I give permis sion to be audiorecorded during a focus group. No, I do not wish to participate in this study . Print Name:

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