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# Draft OMB Clearance Request Promoting Student Success in Algebra I

Appendix F : Consent Forms

February 2013F

– 2 Promoting Student Success in Algebra I Informed Consent: Principal Interview

Purpose
The Office of Elementary and Secondary Education (OESE) of the U.S. Department of Education (ED) requests clearance for the data collection for the Promoting Student Success in Algebra I (PSSA) study

. The purpose of this study is to provide actionable info rmation and greater insight into the knowledge and resources required to enable student success in mathematics between grades 6 through 9, with an emphasis on helping all students complete Algebra I by the end of the ninth grade. To this end, the evaluati on will employ multiple data collection strategies.

To assist with the evaluation, we are asking principals to participate in interviews. You will be interviewed about best practices for improving student success in mathematics and Algebra I, in particular

. The interviews are designed to last no more than one hour.

Risks and Discomfort

There are few anticipated or known risks in participating in this study.

Benefits

Your participation in the evaluation will co ntribute to an understanding of how state and l ocal education agencies can work to improve student outcomes in Algebra I.
Confidentiality

We will treat the information that you supply in a confidential manner. Only selected research staff will have access to data. We will NOT present results in any way that would permit them to be identified with you or any other specific individual. No personally identifiable information, such as name or district affiliation, will be disclosed to anyone outside the project.

More Information

If you would like more information about this study, you may contact the Project Director, Kirk Walters
, at the American Institutes for Research at 202

- 403

- 5838 or at kwalters@air.org . For questions regarding your rights as a subject parti cipating in this research, please contact the Institutional Review Board (IRB)
at IRBChair@air.org or toll free at 1

– 800

– 634

– 0797.

Informed Consent

I have read the above information. I have asked questions and receiv ed answers. I consent to participate in the study.

Signature: ________________________________ Date: ________________________

Print Name: ______________________________ Position: _____________________
District/School: ____________________________F

– 3 Promo ting Student Success in Algebra I Informed Consent: Principal Focus Group

Purpose
The Office of Elementary and Secondary Education (OESE) of the U.S. Department of Education (ED) requests clearance for the data collection for the Promoting Student Success in Algebra I (PSSA) study

. The purpose of this study is to provide actionable information and greater insight into the knowledge and resources required to enable student success in mathematics between grades 6 through 9, with an emphasis on helping all stu dents complete Algebra I by the end of the ninth grade. To this end, the evaluation will employ multiple data collection strategies.

To assist with the evaluation, we are asking principals to participate in a focus group. You will be interviewed about best practices for improving student success in mathematics and Algebra I, in particular. The interviews are designed to last no more than one hour.

Risks and Discomfort

There are few anticipated or known risks in participating in this study.

Benefits

Your participation in the evaluation will contribute to an understanding of how state and local education agencies can work to improve student outcomes in Algebra I.
Confidentiality

We will treat the information that you supply in a confidential manner. On ly selected research staff will have access to data. We will NOT present results in any way that would permit them to be identified with you or any other specific individual. No personally identifiable information, such as name or district affiliation, wil l be disclosed to anyone outside the project.

More Information

If you would like more information about this study, you may contact the Project Director, Kirk Walters, at the American Institutes for Research at 202

- 403

- 5838 or at kwalters@air.org . For questions regarding your rights as a subject participating in this research, please contact the Institutional Review Board (IRB)
at IRBChair@air.org or toll free at 1

– 800

– 634

– 0797.

Informed Consent

I have read the above information. I have asked questions and received answers. I consent to participate in the study.

Signature: ________________________________ Date: ________________________

Print Name: ______________________________ Position: _____________________
District/School: ____________________________F

– 4 Promoting Student Success in Algebra I Informed Consent: Teacher Focus Group

Purpose
The Office of Elementary and Secondary Education (OESE) of the U.S. Department of Education (ED) requests clearance for the data collection for the Promoting Student Success in Algebra I (PSSA) study

. The purpose of this study is to provide actionable information and greater insight into the knowledge and resources required to enable student suc cess in mathematics between grades 6 through 9, with an emphasis on helping all students complete Algebra I by the end of the ninth grade. To this end, the evaluation will employ multiple data collection strategies.

To assist with the evaluation, we are a sking teachers to participate in a focus group. You will be interviewed about best practices for improving student success in mathematics and Algebra I, in particular. The interviews are designed to last no more than one hour.

Risks and Discomfort

There a re few anticipated or known risks in participating in this study. Risks may include possibly feeling coerced to take part in the focus group, however you should know that your participation in this study is entirely voluntary. You will not be penalized in any way for not participating. If you decide to participate, you may discontinue your participation at any time without penalty or loss of benefits to which you are otherwise entitled.

Benefits

Your participation in the evaluation will contribute to an und erstanding of how state and local education agencies can work to improve student outcomes in Algebra I.

Confidentiality

We will treat the information that you supply in a confidential manner. Only selected research staff will have access to data. We will NOT present results in any way that would permit them to be identified with you or any other specific individual. No personally identifiable information, such as name or district affiliation, will be disclosed to anyone outside the project.

More Information

If you would like more information about this study, you may contact the Project Director, Kirk Walters, at the American Institutes for Research at 202

- 403

- 5838 or at kwalters@air.org . For questions regar ding your rights as a subject participating in this research, please contact the Institutional Review Board (IRB)
at IRBChair@air.org or toll free at 1

– 800

– 634

– 0797.

Informed Consent

I have read the above information . I have asked questions and received answers. I consent to participate in the study.

Signature: ________________________________ Date: ________________________

Print Name: ______________________________ Position: _____________________
District/School: _

___________________________F

– 5 Promoting Student Success in Algebra I Informed Consent: Parent Consent for High School Student Focus Group

Purpose
The Office of Elementary and Secondary Education (OESE) of the U.S. Department of Education (ED) requests cleara nce for the data collection for the Promoting Student Success in Algebra I (PSSA) study

. The purpose of this study is to provide actionable information and greater insight into the knowledge and resources required to enable student success in mathematics b etween grades 6 through 9, with an emphasis on helping all students complete Algebra I by the end of the ninth grade. To this end, the evaluation will employ multiple data collection strategies.

To assist with the evaluation, we are asking high school students to participate in a focus group. You will be interviewed about best practices for improving student success in mathematics and Algebra I, in particular. The interviews are designed to last n o more than one hour.

Risks and Discomfort

There are few anticipated or known risks in participating in this study. Risks may include possibly feeling coerced to take part in the focus group, however you should know that your child’s participation in this study is entirely voluntary. Your child will not be penalized in any way for not participating. If your child decides to participate, he/she may discontinue their participation at any time without penalty or loss of benefits to which they are otherwise en titled.

Benefits

Your child’s participation in the evaluation will contribute to an understanding of how state and local education agencies can work to improve student outcomes in Algebra I.

Confidentiality

We will treat the information that your child sup ply in a confidential manner. Only selected research staff will have access to data. We will NOT present results in any way that would permit them to be identified with your child or any other specific individual. No personally identifiable information, su ch as name or district/school affiliation, will be disclosed to anyone outside the project.

More Information

If you would like more information about this study, you may contact the Project Director, Kirk Walters, at the American Institutes for Research at 202

- 403

- 5838 or at kwalters@air.org . For questions regarding your rights as a subject participating in this research, please contact the Institutional Review Board (IRB)
at IRBChair@air.org or toll free at 1

– 800

– 634

– 0797.

Informed Consent

I have read the above information. I have asked questions and received answers. I consent to participate in the study.

Signature: ________________________________ Date: _____________________

___ Print Name: ______________________________ Child’s Name: _____________________
District/School: ____________________________F

– 6 Promoting Student Success in Algebra I Informed Consent: State Official Interview

Purpose
The Office of Elementary and Secondary Education (OESE) of the U.S. Department of Education (ED) requests clearance for the data collection for the Promoting Student Success in Algebra I (PSSA) study

. The purpose of this study is to provide actionable info rmation and greater insight into the knowledge and resources required to enable student success in mathematics between grades 6 through 9, with an emphasis on helping all students complete Algebra I by the end of the ninth grade. To this end, the evaluati on will employ multiple data collection strategies.

To assist with the evaluation, we are asking state officials to participate in interviews. You will be interviewed about best practices for improving student success in mathematics and Algebra I, in particular. The interviews are designed to last no more than one hour.

Risks and Discomfort

There are few anticipated or known risks in participating in this study.

Benefits

Your participation in the evaluation will contr ibute to an understanding of how state and local education agencies can work to improve student outcomes in Algebra I.
Confidentiality

We will treat the information that you supply in a confidential manner. Only selected research staff will have access to data. Our state

- level data collections, by their very nature, focus on policy topics that are in the public domain. Moreover, it would not be difficult to identify Title I and school improvement directors in each state and thus determine the identity of ou r state

- level respondents. Having acknowledged that, we will endeavor to protect the privacy of you, and as with district

- and school

- level respondents, we will avoid using your names in reports and attributing any quotes to specific individuals. We will p rimarily report on the numbers of schools that engage in specific practices, thus avoiding reference to specific schools.

More Information

If you would like more information about this study, you may contact the Project Director, Kirk Walters, at the Ameri can Institutes for Research at 202

- 403

- 5838 or at kwalters@air.org . For questions regarding your rights as a subject participating in this research, please contact the Institutional Review Board (IRB)
at IRBChair@air.org or toll free at 1

– 800

– 634

– 0797.

Informed Consent

I have read the above information. I have asked questions and received answers. I consent to participate in the study.

Signature: ________________________________ Date: ________________________

Print Name: ______________________________ Position: _____________________

State : ____________________________F

– 7 Promoting Student Success in Algebra I Informed Consent: District Official Interview

Purpose

The Office of El ementary and Secondary Education (OESE) of the U.S. Department of Education (ED) requests clearance for the data collection for the Promoting Student Success in Algebra I (PSSA) study

. The purpose of this study is to provide actionable information and grea ter insight into the knowledge and resources required to enable student success in mathematics between grades 6 through 9, with an emphasis on helping all students complete Algebra I by the end of the ninth grade. To this end, the evaluation will employ m ultiple data collection strategies.

To assist with the evaluation, we are asking district officials to participate in interviews. You will be interviewed about best practices for improving student success in mathematics and Algebra I, in particular. The in terviews are designed to last no more than one hour.

Risks and Discomfort

There are few anticipated or known risks in participating in this study.

Benefits

Your participation in the evaluation will contribute to an understanding of how state and local education agencies can work to improve student outcomes in Algebra I.
Confidentiality

We will treat the information that you supply in a confidential manner. Only selected research staff will have access to data. We will NOT present results in any way that would permit them to be identified with you or any other specific individual. No personally identifiable information, such as name or district affiliation, will be disclosed to anyone outside the project.

More Information

If you would like more information about this study, you may contact the Project Director, Kirk Walters, at the American Institutes for Research at 202

- 403

- 5838 or at kwalters@air.org . For questions regarding your rights as a subject parti cipating in this research, please contact the Institutional Review Board (IRB)
at IRBChair@air.org or toll free at 1

– 800

– 634

– 0797.

Informed Consent

I have read the above information. I have asked questions and receiv ed answers. I consent to participate in the study.

Signature: ________________________________ Date: ________________________

Print Name: ______________________________ Position: _____________________

District : ____________________________F

– 8 Promoting St udent Success in Algebra I Informed Consent: Department Chair/Teacher Leader Interview

Purpose
The Office of Elementary and Secondary Education (OESE) of the U.S. Department of Education (ED) requests clearance for the data collection for the Promoting Stu dent Success in Algebra I (PSSA) study

. The purpose of this study is to provide actionable information and greater insight into the knowledge and resources required to enable student success in mathematics between grades 6 through 9, with an emphasis on he lping all students complete Algebra I by the end of the ninth grade. To this end, the evaluation will employ multiple data collection strategies.

To assist with the evaluation, we are asking Department Chairs and Teacher Leaders to participate in intervie ws. You will be interviewed about best practices for improving student success in mathematics and Algebra I, in particular. The interviews are designed to last no more than one hour.

Risks and Discomfort

There are few anticipated or known risks in participating in this study.

Benefits

Your participation in the evaluation will contribute to an understanding of how state and local education agencies can work to improve student outcomes in Algebra I.
Confidentiality

We will treat the information that you supply in a confidential manner. Only selected research staff will have access to data. We will NOT present results in any way that would permit them to be identified with you or any other specific individual. No personally identifiable information, su ch as name or district affiliation, will be disclosed to anyone outside the project.

More Information

If you would like more information about this study, you may contact the Project Director, Kirk Walters, at the American Institutes for Research at 202

- 40 3

- 5838 or at kwalters@air.org . For questions regarding your rights as a subject participating in this research, please contact the Institutional Review Board (IRB)
at IRBChair@ air.org or toll free at 1

– 800

– 634

– 0797.

Informed Consent

I have read the above information. I have asked questions and received answers. I consent to participate in the study.

Signature: ________________________________ Date: ________________________

Print Name: ______________________________ Position: _____________________
District/School: ____________________________F

– 9 Promoting Student Success in Algebra I Informed Consent: Pro fessional Development Provider I nterview

Purpose

The Office of Elementar y and Secondary Education (OESE) of the U.S. Department of Education (ED) requests clearance for the data collection for the Promoting Student Success in Algebra I (PSSA) study

. The purpose of this study is to provide actionable information and greater ins ight into the knowledge and resources required to enable student success in mathematics between grades 6 through 9, with an emphasis on helping all students complete Algebra I by the end of the ninth grade. To this end, the evaluation will employ multiple data collection strategies.

To assist with the evaluation, we are asking professional development providers to participate in interviews. You will be interviewed about best practices for improving student success in mathematics and Algebra I, in particula r. The interviews are designed to last no more than one hour.

Risks and Discomfort

There are few anticipated or known risks in participating in this study.

Benefits

Your participation in the evaluation will contribute to an understanding of how state and local education agencies can work to improve student outcomes in Algebra I.
Confidentiality

We will treat the information that you supply in a confidential manner. Only selected research staff will have access to data. We will NOT present results in any wa y that would permit them to be identified with you or any other specific individual. No personally identifiable information, such as name or district/school affiliation, will be disclosed to anyone outside the project.

More Information

If you would like more information about this study, you may contact the Project Director, Kirk Walters, at the American Institutes for Research at 202

- 403

- 5838 or at kwalters@air.org . For questions regarding your ri ghts as a subject participating in this research, please contact the Institutional Review Board (IRB)
at IRBChair@air.org or toll free at 1

– 800

– 634

– 0797.

Informed Consent

I have read the above information. I have asked questions and received answers. I consent to participate in the study.

Signature: ________________________________ Date: ________________________

Print Name: ______________________________ Position: _____________________
District/School: __________

__________________