PE Teacher Focus Group - Consent

Form Approved

OMB No. 0920-xxxx

Exp. Date xx/xx/xxxx

PE TEACHER FOCUS GROUP CONSENT

The Presidential Youth Fitness Program (PYFP) has partnered with the Centers for Disease Control and Prevention, the Robert Wood Johnson Foundation and ICF International to conduct an evaluation of the (PYFP). The goal of this focus group is to understand your perspectives, experiences, and insights about implementing the Presidential Youth Fitness Program at this school, including what has worked well, what have been challenges, and recommendations to improve the Presidential Youth Fitness Program. This focus group should take about 60 minutes, and you can refuse to answer a question or end your participation in the focus group at any time. We will maintain confidentiality throughout the entire project and your names will not be associated with anything you say in any of the reports or documents resulting from this evaluation.

Taking part in the focus group will cause little or no risk. You will receive no immediate benefit for participating in the focus group other than the knowledge of knowing you are helping to contribute information that will ultimately be used for the purposes of program improvement. The questions will focus on your opinions and experiences, and there are no right or wrong answers. If the focus group occurs outside of school hours you will receive a $15 gift card in appreciation for your participation.

I have read this form and know what the PYFP Evaluation is about.

[ ] Yes, I agree to participate in the PE Teacher Focus Groups

[ ] No, I do not wish to participate in the PE Teacher Focus Groups

Signature: ________________________________ Date: _____________________

Print Name: ___________________________________________________________

If you have any questions or concerns, please contact Isabela Lucas, Project Manager for the PYFP Evaluation, at ICF International: Isabela.Lucas@icf.com or 404-592-2155.