American Institutes for Research Task Order 18: Study on Sustaining the Positive Effects of Preschool—B-1

1695_03/15

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 early 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 participate 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 designed 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 participate, 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, we 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 be 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 at any time.
American Institutes for Research Task Order 18: Study on Sustaining the Positive Effects of Preschool—B-2

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 

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 any questions I had and received 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 estimated 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, Washington, DC 

20202, directly. (Note: Please do not return the completed instrument, form, application, or survey to this 

address.)