Ameri can Institutes for Research Task Order 18: Study on Sustaining the Positive Effects of Preschool

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# Appendix B **. Consent Form** 

**Study of Practices to Sustain the Effects of Preschool**

**Informed Consent Purpose**  American Institutes for Research (AIR), under contract with the Policy and Program Studies Service (PPSS) within the U.S. Department of Education, is conducting a study of practices in early elementary school to sustain the effects of preschool . The purpose of the study is to document characteristics of programs and policies in e arly

elementary school that support student growth and development, such as K

– 3 alignment and differentiated instruction . We are interested in learning more about the theoretical or practical background of these programs, how they are implemented, and how they are sustained and resourced . To this end, the study will employ multiple data collection strategies. To assist with the study, we are asking district administrators, principals, and teachers, along with other relevant staff and stakeholders, to partic ipate in interviews or focus groups. You will be interviewed about topics related to practices in your district and school to support students after they arrive in elementary school after having attended preschool. The interviews or focus groups are design ed to last [ if district: 90 minutes/ if other respondent: no more than one hour.] . **Risks and Discomfort** 

### We do not know of any risks or discomforts associated with this interview. Your participation in the interview is voluntary. If you decide to participa te, you may discontinue your participation in the interview at any time without penalty of any kind. **Benefits** Your participation in the evaluation will contribute to an understanding of how elementary schools can continue to support the growth and development of students in early elementary gains, through K

– 3 alignment and differentiated instruction. **Freedom to Withdraw** Your participation in this research study is voluntary . You may pass on any question that is asked and you may withdraw from the study at any time. **Privacy** Responses to this data collection will be used only for research purposes . No part of the study involves evaluation of any individual. Though your site ’s name will appear in the final report, w e will not provide your name in any

reporting or to anyone outside the study team, except as required by law. Because we are producing case studies of only a small number of named sites , it may be possible for a reader to identify you based on the data that we report , even though your name will not b e used. If there is information that you do not want shared directly in any reporting, please let me know. We would like your consent to record the interview. Recordings will be kept in a secure location by SRI International and will not be accessed by anyone outside the study team. The audio recordings will be destroyed at the conclusion of the study. You can participate in the interview but decline to have it recorded. Additionally, if you elect to have the interview recorded, you may stop the recording a t any time.Ameri can Institutes for Research Task Order 18: Study on Sustaining the Positive Effects of Preschool

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**More Information** If you would like more information about this study, you may contact the Project Director, Kathryn Drummond, at AIR at 541 - 521 - 8517 or kdrummond@air.org . For questions regarding your rights as a subject participatin g 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 any questions I had and rec eived answers. I consent to participate in the study. **Signature:**

**________________________________ _____________**  **Date:**

**____________________________ Print Name:** 

**________________________________ ___________**  

### According to the Paperwork Reduction Act of 1995 , no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this information collection is xxxx - xxxx. Public reporting burden for this collection is estimate d to average 75 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. There is no obligation to respond to this collection ; participation is voluntary. If you have comments or concerns about the status of your individual submission of this form, application , or survey, please contact Erica S. Lee, U.S. Department of Education, Policy and Program Studies Service, 400 Maryland Ave. SW, Washin gton, DC 20202 , directly. (Note: Please do not return the completed instrument, form, application , or survey to this address.)