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 Laboratory (REL) Midwest to study the 

implementation of a schoolwide guidance program called Ramp-Up to Readiness (“Ramp-Up”) 

developed by the College Readiness Consortium at the University of Minnesota. REL Midwest, 

operated by American 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 study has been submitted to IES for research approval. An application also 

will be submitted to the Office of Management and Budget for review.

REL Midwest invites you and other school staff to participate in the study, which will begin this 

spring. The study involves the following data collection activities, which you may be asked to 

participate in:

 Two focus groups, one in February and one in May

 Short instructional logs following each of five Ramp-Up college workshops

 An online survey in the spring 2014

Voluntary Participation

Participation in the data collection activities is voluntary. You also can withdraw from the study 

at any 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 ensure that individually identifiable data will be used only for statistical 

purposes and will be accessible only to authorized persons.

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

Responses 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 

any specific individual. The researchers will not provide information that identifies you or your 

school to anyone 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, you are indicating that you have read and understood the information 

provided to you about your participation.

Yes, I want to participate in this study.

Yes, I give permission to be audiorecorded during a focus group.

No, I do not wish to participate in this study.

Print Name: _______________________________________________________________

Signature: ________________________________________________

Date: __________________

School Name: __________________________________________________________

According to the Paperwork Reduction 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 is estimated to average 15 minutes per respondent, including the time to review 

instructions, gather the data needed, and complete and review the information collected. 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.