# OMB Clearance Request

**Promoting Student Success in Algebra I**
**Appendix F: Informed Consent Form Promoting Student Success in Algebra I**  **: Profiles of Practice**  **Informed Consent Purpose**  The Office of Elementary and Secondary Education (OESE) of the U.S. Department of Education (ED) has contracted with the American Institutes for Research (AIR) to conduct the Promoting Student Success in Algebra I (PSSA) project. The purpose of this project is to provide actionable information about and greater insight into the knowledge and resources required to enable student s to succe ed in mathematics in G rades 6 through 9, with an emphasis on helping all students complete Algebra I by the end of G rade 9
. To this end, PSSA will conduct literature reviews as we ll as focus group and on

- site data collections to generate a series of user

-friendly technical assistance briefs that showcase promising practices in mathematics professional development, instruction al coaching, instructional practices, curricular alignment, and supplementary algebra. To assist with th is project , we are asking district officials , principals, teachers, coaches, and students to participate in a 30
- 6 0
- minute interview or focus group to discuss their experiences developing, implementing, and/or participating in strategies related to one of the project’s five areas of interest. **Risks and Discomfort** There are few anticipated or known risks in participating in this study. **Benefits** Your participation in the study will contribute to an understanding of how state and local education agencies can work to improve student outcomes in Algebra I. **Confidentiality** Responses to this data collection will be used to summarize findings in an agg regate manner (within a school or district), or will be used to provide examples of implementation in a manner that does not associate responses with a specific site or individual. In the publications, pseudonyms will be used for each site. The project te am may refer to the generic title of an individual (e.g., "project director," or "eighth grade teacher") but neither the site name nor the individual name will be used. All efforts will be made to keep the description of the site general enough so that a reader would never be able to determine the true name or identity of the site or individuals at the site. The contractor will not provide information that associates responses or findings with a subject or district to anyone outside the study team, except as required by law.**More Information**

If you would like more information about this project , 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 Cons ent**  I have read the above information. I have asked questions and received answers. I consent to participate in the study. I understand that participation in this study is voluntary and that I may discontinue my participation at any time.
**Signature: _____**

**___________________________ Date: ________________________**  **Print Name: ______________________________ Position: _____________________**  **District: ____________________________ School**  **: _____________________**