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 #P21494

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 Yee
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Appendix C: Participant Phone Interview Verbal Consent

Study of Experiences and Needs of REAP Grantees

PARTICIPANT PHONE INTERVIEW VERBAL CONSENT 

INSTRUCTIONS TO INTERVIEWER

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 key points in each paragraph should be 

addressed, the last question needs to be asked, and you must ask for permission to audio record.

1. Hello, this is _______________ and I’m calling from SRI International about our interview as part 

of the study of the Rural 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.
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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 contract for 

the U.S. Department of Education by SRI International (SRI), an independent, nonprofit research 

institute, and Impaq 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 changing 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 

performance. There are no anticipated or known risks in participating in this study.

Your participation in the study will contribute to identifying REAP-related practices that might 

warrant further study, identifying grantee technical assistance needs, and help inform the 

reauthorization of the Elementary and Secondary Education Act.

The study will keep individual responses confidential , except as may be required by law. The 

study will assigned unique identification numbers to individuals and to sites for 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 from 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 Committee at (650) 859-2686 and reference case number XXXX-XXXX.
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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 __________________________