Agreement to Participate in the National Guard Youth ChalleNGe Job ChalleNGe Evaluation
You are invited to be part of the National Guard Youth ChalleNGe Job ChalleNGe Evaluation. This form explains what it means to be in the study. To join the study, sign your name at the end of the form. If you are younger than 18 years old, then your parent or guardian will also need to sign an agreement form.
What is the National Guard Youth ChalleNGe Job ChalleNGe Evaluation?
It is a study to learn whether the Youth ChalleNGe and Job ChalleNGe programs improve the educational and job market prospects and reduce the criminal justice involvement of the youth they serve. The study is run by three organizations: Mathematica Policy Research, MDRC, and Social Policy Research Associates. The U.S. Department of Labor is sponsoring the study.
Who can be in the study?
Every Youth ChalleNGe participant can be in the study.
What does it mean to be in the study?
There are two parts of this study: (1) the evaluation of the Youth ChalleNGe program and (2) the evaluation of the Job ChalleNGe program. Each part has different requirements and not everyone can be involved in both. Even if you know you don’t want to be in the Job ChalleNGe program, you can still participant in the first part of this evaluation. The information you give us, no matter how much, is very important to the success of the study!
The Youth ChalleNGe evaluation:
The study team will collect information on you from several sources:
Background Information Form. It will collect information such as address, phone number, social media accounts, and questions on your education and involvement in the juvenile/adult criminal justice system.
Participation in discussion groups. A small group of particiants will be asked to speak with evaluation staff in a group setting. Questions will be asked about what it was like to get into the Youth ChalleNGe program, experiences in the pre-ChalleNGe part of the program, the activities and help you receive as part of Youth ChalleNGe and involvement in mentoring.
Program and government records. These records may include information from the National Guard Bureau about your program activities. They may also include information at state and federal agencies about your employment and earnings, education, and involvement in juvenile and adult criminal justice systems.
The Job ChalleNGe evaluation:
As a participant in the Youth ChalleNGe program, you might be given the opportunity to be a part of the Job ChalleNGe program. Because it is not possible for everyone to be accepted into the program, Youth ChalleNGe program participants who meet certain requirments such as successful completion of the program will be chosen at random for the Job ChalleNGe program. Selecting participants at random gives everyone a fair and equal chance at being chosen for the program. The selection is like a lottery; it has nothing to do with your age, race, gender or anything else about you. Even if you do not get an invitation to join the Job ChalleNGe program, you will continue to be part of this study.
If you are part of the Job ChalleNGe evaluation, you might be asked to complete a survey. You will receive a payment for taking the survey. You do not have to do the survey or answer any questions that make you uncomfortable.
How will the study use my information?
The study team will use your information for research purposes only, to learn about how these programs work and how they may help people. The team will follow strict rules to protect your privacy. Your information will be kept private and confidential. Your name will never be used in any report written for the project. To help us protect your privacy, we have obtained a Certificate of Confidentiality from the National Institutes of Health. The researchers can use this Certificate to legally refuse to disclose information that may identify you in any federal, state, or local civil, criminal, administrative, legislative, or other proceedings, for example, if there is a court subpoena. The researchers will use the Certificate to resist any demands for information that would identify you. However, the study team must report your information if you tell us that you or someone else is in danger. In addition, the government may see your information if it audits Mathematica, MDRC, or Social Policy Research Associates but it, too, will protect your privacy.
You will help Youth ChalleNGe and Job ChalleNGe programs learn how to provide better services for young people like you.
Even if you are not selected for the Job ChalleNGe program, you will still be part of the study and will have access to post-residential Youth ChalleNGe services.
There is a small risk of a breach of confidentiality; however, strong precautions will be taken to protect your information.
Do I have to be in the study?
No. The decision to be in the study is your choice. However, only people who are in the study will have a chance to be in the Job ChalleNGe program. You may drop out of the study at any time by contacting Mathematica (see below). If you drop out, the study team still may use the information collected while you were in the study.
I have read this form and understand the information presented.
I agree to be in the National Guard Youth ChalleNGe Job ChalleNGe Evaluation.
I know the decision to be in the study is my choice.
I know that I will have a chance to be in the Job ChalleNGe program. If I am not selected, I will not be able to be in the program for 2 years.
I understand I can drop out of the study at any time.
I know that the study team will follow strict rules to protect my privacy. My name will never appear in any public document.
I understand that the study team will get information about me. The information will come from programs and agencies, as described above.
I understand that my education records are protected under a federal law called the Family Educational Rights and Privacy Act (FERPA). I further understand that I may waive that protection and give the study team access to my records. I agree to waive my rights under FERPA; the study team can get education records about me.
I understand that I may be contacted to take part in a survey. I know I do not have to participate in the survey, and if I choose to participate, I know I do not have to answer any questions that make me uncomfortable.
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My Date of Birth (e.g. 01/01/1995)
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My Social Security Number (e.g. 123-45-6789)
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My Name (Please Print)
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My Signature
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Date
Questions about the National Guard Youth ChalleNGe Job ChalleNGe Evaluation? You can reach a study team member by phone at 866-XXX-XXXX or by email at XXX@mathematica-mpr.com.
Federal Law called the Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99) is a Federal law that protects the privacy of your education records. Generally, schools must have permission from you or your parent in order to release your education records. When you sign this form, you will give permission to the study team to get your education records.
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| File Type | application/msword |
| Author | Irwin, Molly E - ASP |
| Last Modified By | Irwin, Molly E - ASP |
| File Modified | 2016-03-25 |
| File Created | 2016-03-25 |