Youth Challenge Infromed Consent

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 the 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 volunteer who is eligible for the Youth ChalleNGe program can be in the study.

What does it mean to be in the study?

You have a chance to get into the Youth ChalleNGe and Job ChalleNGe programs. Because it is not possible for everyone to be accepted into the program, eligible participants will be chosen for the program at random. 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 a program, you will continue to be part of this study.

If you agree to be a part of the study, you will be informed as to whether you were selected to participate in the Youth ChalleNGe program. Remember, not everyone who is interested in the program can be a part of it.

If you are selected to participate in the Youth ChalleNGe program, you might also be given the opportunity to be a part of the Job ChalleNGe program. Youth ChalleNGe program participants who meet certain requirements such as successful completion of the program will be placed into a lottery like the one used for Youth ChalleNGe selection. Again, not all Youth ChalleNGe participants who completed the program and are interested in Job ChalleNGe will be able to be a part of the Job ChalleNGe program.

For the evaluation of these programs, the study team will collect information on you from several sources:

• Background Information Form. You will be asked to complete this form during your application process. 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.

• Survey. The study team might ask you to complete a survey 18 months after random assignment occurs. You will receive a payment for taking this survey, although you do not have to complete the survey or answer any questions that make you uncomfortable.

• 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.

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.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.

What are the benefits and risks of participating in the study?

You will help Youth ChalleNGe, Job ChalleNGe, and other programs learn how to provide better services for young people like you.

Even if you are not selected for the Youth ChalleNGe or Job ChalleNGe programs, you will still be part of the study and will have access to other services in your community.

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 Youth ChalleNGe and Job ChalleNGe programs. You may drop out of the study at any time by contacting Mathematica (see below). If you drop out, the study team may use the information collected while you were in the study.

Statement

• 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 Youth ChalleNGe and Job ChalleNGe programs. 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.

___________________________________________

My Date of Birth (e.g. 01/01/1995)

___________________________________________

My Social Security Number (eg. 123-45-6789)

___________________________________________

My Name (Please Print)

___________________________________________

My Signature

_______________________

Date

____________________________________________

Name of Parent/Guardian if Under 18 (Please Print)

___________________________________________

Signature of Parent/Guardian

_______________________

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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