Phase 2 school staff consent form

[HIGH SCHOOL LETTERHEAD]

Staff Consent Form
Purpose
Our school has partnered with the Regional Educational Laboratory (REL) Midwest to study the
implementation of a schoolwide guidance program called Ramp-Up to Readiness (“Ramp-Up”)
developed by the College Readiness Consortium at the University of Minnesota. REL Midwest,
operated by American Institutes for Research, is sponsored by the Institute of Education Sciences
(IES) at the U.S. Department of Education. The evaluation will examine how school staff
members implement Ramp-Up and how the intervention compares with college-readiness
supports in other high schools. The study has been submitted to IES for research approval. An
application also will be submitted to the Office of Management and Budget for review.
REL Midwest invites you and other school staff to participate in the study, which will begin this
fall and continue into the spring. The study involves the following data collection activities, in
which you may be asked to participate:


An online survey administered in the fall and spring of this academic year



Short instructional logs following each of five Ramp-Up college workshops

Voluntary Participation
Participation in the data collection activities is voluntary. You also can withdraw from the study
at any time. Individuals who decline to participate or later withdraw from the study will face no
personal or professional repercussions.
Risks
There are few anticipated or known risks in participating in this study. Data collected and
maintained by, or under the auspices of, IES under a pledge of confidentiality shall be treated in
a manner that will ensure that individually identifiable data will be used only for statistical
purposes and will be accessible only to authorized persons.
Benefits
Your participation in the evaluation will contribute to an understanding of a schoolwide college
readiness program that seeks to improve the college readiness outcomes of all students. You will
also receive a $25 gift card from Amazon.com for participating in the data collection activities.

Confidentiality
Responses to this data collection will be used only for statistical purposes. The reports prepared
for this study will summarize findings across the sample and will not associate responses with
any specific individual. The researchers will not provide information that identifies you or your
school to anyone outside the study team, except as required by law.
More Information
If you would like more information about this study, you may contact Jim Lindsay of REL
Midwest at 630-649-6591.
Informed Consent
By signing this form, you are indicating that you have read and understood the information
provided to you about your participation.

Yes, I want to participate in this study.
No, I do not wish to participate in this study.
Print Name: _______________________________________________________________
Signature: ________________________________________________
Date: __________________
School Name: __________________________________________________________
Position at School: ___________________________________________________________

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid
OMB control number. The valid OMB control number for this information collection is 1850-XXXX, OMB expiration date is XXXX, XX, 2017.
The time required to complete this information collection is estimated to average 5 minutes per respondent, including the time to review
instructions, gather the data needed, and complete and review the information collected. If you have any comments concerning the accuracy of the
time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education, Washington, DC 20202. If you have
comments or concerns regarding the status of your individual submission of this form, write directly to: U.S. Department of Education, Institute of
Education Sciences, 555 New Jersey Avenue, NW, Washington, DC 20208.