Emerging Leaders Initiatives

Appendix B-2 Consent Form

The U.S. Small Business Administration’s (SBA’s) Office of Entrepreneurial Development (OED) will conduct an evaluation of the Emerging Leaders initiative. The following survey has been designed to learn about Emerging Leaders participants, their businesses, and their experience with the initiative. The primary purpose of this data collection effort is to determine if the initiative is effective and to find ways to improve Emerging Leaders and other small business assistance programs and initiatives funded by SBA.

Confidentiality and Usage

SBA’s contractor for the Emerging Leaders initiative, Interise, will securely collect and store your responses to this survey and provide them to SBA for analysis. Any information provided in this survey will be kept strictly confidential. In the context of this survey, confidentiality is defined to mean that no respondent will be identified or named in any publicly available report or other such publication without your prior permission. Your personal information will be protected to the extent permitted by law, including the Privacy Act of 1974 and the Freedom of Information Act (FOIA). In addition, to the extent permitted under FOIA, confidential business information will not be disclosed to parties outside of SBA and its contractors. The results from the survey will be stored on a secure server accessible to SBA and its contractors. The survey data will be retained by SBA contractors for no fewer than 3 years after the completion of the surveys and will not be used for purposes outside of SBA contracts during or after that period. Survey data with identifying information will be transferred to SBA using encrypted files and/or connections.

If you understand and agree with the conditions described here, please check the appropriate box and type your full name below. The research team will not use the information provided for any reason without your permission other than those stated in this consent form.

1. I do not consent

2. I consent

_______________________________

Signature