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 students to succeed in 

mathematics in Grades 6 through 9, with an emphasis on helping all students complete Algebra I by the 

end of Grade 9. To this end, PSSA will conduct literature reviews as well 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, instructional coaching, instructional practices, 

curricular alignment, and supplementary algebra.

To assist with this project, we are asking district officials, principals, teachers, coaches, and students to 

participate in a 30-60-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 aggregate 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 team 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 Consent

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: _____________________