### June 18 , 2014



# Fourth **Draft OMB Package , Version Two**  **Appendix C –**  **Phone Interview Consent Form PPSS TO 10:**  **Studies of Rural Education Achievement Program (REAP) Grantees Subtask 3**  **. 5**  **: Prepare Fourth**  **Draft OMB Clearance Package** Contract Number GS - 10F - 0554N; Order Number ED - PEP - 11 - O -0090 SRI Project # P 21494

**Submitted to:** Andrew Abrams Policy and Program Studies Service U.S. Department of Education 400 Maryland Avenue, SW Washington, DC 20202 **Prepared by:** SRI International Kyra Caspary, Chris Padilla, Nancy Adelman, Rebecca Schmidt, Erica Harbatkin , and Kaily Yee1



### Appendix C: Participant Phone Interview Verbal Consent



## Study of Experiences and **Needs of REAP Grantees PARTICIPANT**  **PHONE INTERVIEW VERBAL CONSENT I**  **NSTRUCTIONS TO INTER VIEWER**  Prior to the interview send the Interviewee Study Description to the potential interviewee. The entire script below does not have to be read verbatim, but the k ey points in each paragraph should be addressed, the last question needs to be asked, and you must ask for permission to audio record. 1. H ello , this is _______________ and I’m calling from SRI International about our interview as part of the study of the Ru ral Education Achievement Program (or REAP) . Is this still a good time to talk? I anticipate the interview taking between 30 and 60 minutes. **[If, no.]** Try to reschedule interview. STOP **[If, yes].** Move on to #2. 2. Great. Have you had a chance to read the study description that I sent you? **[If, no]** Move on to #3. **[If, yes]**. Great. Move on to #4.2

3. If, no, you may give them an opportunity to read the description or read the script below. Before we begin, let me give you a brief outline of the study again and go over your rights as a research participant. As you know, this interview is part of the Study of Experiences and Needs of REAP Grantees. This evaluation of the REAP program is being carried out under contr act for the U.S. Department of Education by SRI International (SRI) , an independent, nonprofit research institute , and Impa q International (Impaq) . The purpose of this study is to document and analyze practices funded by REAP — by itself or in combination with other federal funds — as well as how the components of the program work to help address the challenges faced by rural districts. This interview will include questions about program administration, technical assistance needs, and recommendations for c hanging the REAP program to better meet the needs of rural districts. The interviews are designed to last 30–60 minutes. The interviews are intended to provide information about the overall program and not to evaluate individuals in their capabilities or p erformance. There are no anticipated or known risks in participating in this study. Your participation in the study will contribute to identify ing REAP - related practices that might warrant further study, identify ing grantee technical assistance needs , and help inform the reauthorization of the Elementary and Secondary Education Act . The study will keep i ndividual responses confidential , except as may be required by law. The study will assigned u nique identification numbers to individuals and to sites fo r the data collected. Only research staff will have access to your interview responses. You will not be identified by name in any report and data will be reported in a manner that does not reveal your identify. As part of the evaluation, the SRI research team will share its findings with the U.S. Department of Education and other federal agencies. The results of the study will be summarized across all the districts or states participating in the study. A publicly available report summarizing the findings f rom the study will be made available in late 2015. If you have questions later, please call SRI at (800) xxx-xxxx or email reap@sri.com . For questions about your rights as a human participating in this research, you may contact SRI’s Human Subjects Committ ee at (650) 859 - 2686 and reference case number XXXX-XXXX .3

4. Did you have any questions about the study or your rights as a research participant? **[If yes]** Answer questions if asked. Move on to #5. **[If, no]** Great. Move on to #5. 5. We would like to audio record the interview with you for accuracy? Is that okay with you? [ **If, yes.** Move on to #6] [ **If, no.** Move on to #6, but do NOT audio record. ] 6. If you don’t have any more questions, could you please confirm that you voluntarily consent to participating in this interview? [interviewer checks yes or no box] [ ] YES [ ] NO
Name of Interviewee __________________________ Date of Interview ___

________ Position & State/School District __________________________