Student Assent and Baseline Forms

Attachment 2

Informed Assent Form

The Upward Bound Research Study

This year, the U. S. Department of Education is studying the Upward Bound program. Three companies named Abt Associates, the Urban Institute, and Berkeley Policy Associates are doing the study. More than 3,500 students are going to be in the study. It will help us learn about how Upward Bound helps students in high school get ready for college. We are also asking your parents for permission for you to be in the study, but we would like you to know about it and to agree to be in it.

Right now there are not enough openings for all the students who want to be in Upward Bound. So students will be chosen by lottery to get into this Upward Bound program. We are asking all students applying to Upward Bound to be in this study. If you go through the lottery and do not get into Upward Bound you would still be part of the study. You can also be in any other program you qualify for. If you agree to be in the study, you will need to answer some questions. In about two years, we will ask you another set of questions. We are also asking for permission to collect some of your school records.

If you are part of the study, you will help us learn ways in which to improve programs to help students prepare for college. However, whether you are part of the study is up to you.

What it Means to Be in the Study

If you want to be in the lottery for the Upward Bound program, you should first complete the form below. This form will tell us whether you agree to be in the study. If you agree to be in the study, we will ask you some questions before the lottery takes places, and again in about two years. All the questions are important to the study, but you can decide not to answer any question you don’t like. We will also gather your school records in about two years and before you turn 18. If you decide not to be in the study, it won’t prevent you from getting into any program or service. After you complete the Upward Bound application, Abt Associates will decide by lottery who will get into in the program and who will not. Whether you decide to be in the study or not, you still have to go through the lottery to get into Upward Bound. But we really want you to be in the study and help us learn how to make Upward Bound a better program.

Privacy

The U. S. Department of Education, Abt Associates, the Urban Institute, and Berkeley Planning Associates follow strict rules to protect your privacy and the privacy of any information you give us. No report will describe you in any way that could identify you or your school. Your answers will be kept private from Upward Bound and school staff, employers, friends, and your family. No one will see your answers to this survey or future surveys besides trained members of the study team, except as required by law.

Whenever you give information on yourself to others, there is a chance that someone will see the data without permission. We have good security procedures, so the chance of that happening is very small. Your identity, survey responses, and school records will be kept private to the extent allowed by law.

Questions About the Study

If you have any questions about the survey please call 1-800-____-______ (toll free). If you have other questions about the study, please contact Dr. Alan Werner, Study Director, at 617-349-2832 (toll call). Questions about study participants’ rights should be addressed to Ms. Marianne Beauregard at Abt Associates, at 617-349-2852 (toll call).

1. Please read the following statement. The Upward Bound program to which I am applying is part of a national study. This U.S. Department of Education study is being conducted by Abt Associates, the Urban Institute, and Berkeley Policy Associates. The purpose of the study is to learn how Upward Bound helps students succeed in high school and prepare for college. We would like you to participate in this important study. If you participate, we will collect survey information both now and two years from now. We also will collect some of your school records. The information gathered on you will be kept strictly confidential and will be used ONLY for the purpose of the study, except if required by law. 2. After reading the above statement, do you agree to participate in the National Evaluation of Upward Bound?
	YES, I agree to participate in the National Evaluation of Upward Bound.
	NO, I do NOT agree to participate in the National Evaluation of Upward Bound.
Print Your Name: First Name Last Name
Signature: Date:

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number The valid OMB control number for this information collection will be entered after clearance. The time required to complete this information collection is estimated to average 15 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.

Abt Associates Inc. Student Assent Form 1