### Per the policies and procedures required by the Education Sciences Reform Act of 2002, Title I, Part E,

Section 183, responses to this data collection will be used only for statistical purposes. The reports prepared for this study will summarize findings a cross the sample and will not associate responses with a specific district or individual. Any willful disclosure of such information for nonstatistical purposes, except as required by law, is a class E felony. 

### The On

- Time Graduation Study Interview Consent Form

DESCRIPTION Thank you for taking the time to participate in the On

- Time Graduation Study data

- team interview. The On

- Time Graduation Study is being conducted by the Midwest Regional Educational Laboratory at American Institutes for Research (AIR). It is funded by the U.S. Department of Education, Institute of Education Sciences and will run from January 2014 through the spring of 2016. The purpose of this interview is to better understand how schools work with the EWIMS tool and seven

- step process to identify and inter vene with students who may be at

- risk for dropping out of high school.

PROCEDURES Participation includes a telephone interview of approximately 90 minutes in length with a project team member and facilitator. To facilitate the interview process, conversations will be digitally recorded and transcribed.

RISKS, DISCOMFORTS & INCONVENIEN CES There are no known risks for participation. Your participation in this study is voluntary. You will not be penalized in any way for not participating. If you decide to participate, you may discontinue at any time without penalty and you may choose not to answer specific questions.

CONFIDENTIALITY The information we obtain from the interviews will be kept in strict confidence to the fullest extent permitted by law. Information that could identify individuals will not be shared with anyone outside of the study team. All digitally recorded files and summaries will be given codes and stored separately from any names or other direct identification of participants. All reports prepared for this study will summarize findings across the sample and will
not asso ciate responses with a specific individual. The digital files will be destroyed once all reporting activities are completed.

BENEFITS Your participation will help the U.S. Department of Education better understand how schools use data to identify and inte rvene with students who may be at

- risk for dropping out of high school.

MORE INFORMATION Upon completion of the interview, you will receive a $30 gift card. If you have any questions about the gift cards, please contact Suzanne Stachel at sstachel@air.org or 202

- 403

- 5584. If you have any questions or concerns about this interview, please contact Dr. Ann

- Marie Faria, Project Director, at afaria@air.org or 202

- 403

- 5356.

If you have concerns or questions about your rights as a participant, contact AIR’s Institutional Review Board (which is responsible for the protection of project participants) at IRB@air.org , toll free at 1

- 800

- 634

- 0797, or c/o IRB, 1000 Thomas Jefferson Street, NW, Washington, DC 20007.

INFORMED CONSENT

 

### YES

, I have read and understand the information above and give my consent to participate in the On

- Time Graduation Project interview.

 

### NO

, I have read and understand the information above and do not give my consent to participate in the On

- Time Graduation Project interview.