Appendix B-9 - Parent Interview Consent Form

OMB Control No.: 0970-xxxx

Expiration Date: xx/xx/20xx

Appendix B-9: Participant Consent Form for On-Site Interviews: Head Start Parents

School Readiness Goals and Head Start Program Functioning

Informed Consent for Participation

• You are being invited to participate in a research study called “School Readiness Goals and Head Start Program Functioning,” conducted by Monica Rohacek and Heather Sandstrom at the Urban Institute, a non-profit research organization in Washington, D.C. This study is currently funded by the U.S. Department of Health and Human Services.

• The purpose of this study is to learn more about how Head Start and Early Head Start programs set their school readiness goals, how they measure progress toward these goals, how the school readiness goals requirement is affecting program planning and operations, as well as how programs view the school readiness goals requirement.

• Participation in this study is completely voluntary. You may choose to not answer any question and may stop the interview at any time. There are no consequences for choosing not to participate or not to answer any question.

• The interview will last about 45 minutes.

• As a token of appreciation, you will be offered $25 cash at the end of the interview.

• Although you may not benefit directly from this study, your participation will help us understand the experiences of Head Start programs, which may inform future Head Start policies and technical assistance efforts.

The research team will take the following steps to protect your privacy:

• Everyone who works on this study has signed a Staff Confidentiality Pledge prohibiting disclosure of anything you say during the interview that would allow someone outside the research team, including government staff and officials, to identify you. The only exception is a researcher may be required by law to report suspicion of immediate harm to yourself, to children, or to others.

• Your name and other identifying information, such as the program’s name and specific location, will be removed from the data to protect your privacy.

• The researchers plan to publish the results of this study in a final report and research briefs, and present the results during several government briefings and national conferences. Your answers will be kept private, meaning your identity will never be revealed in the results.

• With your permission, we will audio record the session. The recording will serve as a back-up tool to ensure that we capture all your comments in our notes in as close to your words as possible. The digital recording will be kept in secured files at the Urban Institute accessible only to project staff. Once the project is complete, all recordings will be destroyed.

If you have questions about this study, you may contact Co-Principal Investigator Heather Sandstrom at the Urban Institute, 2100 M Street NW Washington, DC 20037, at (202) 261-5833 or hsandstrom@urban.org.

Signing this consent form indicates that you understand the study procedures and are willing to participate in this interview.

_________________________________________

Respondent’s Name (PLEASE PRINT)

_________________________________________ _________________________

Respondent’s Signature Date

□ Checking this box indicates that you agree to have the interview audio recorded.

You will be given a copy of this form for your records.

This information collection is voluntary and will be used to learn how Head Start and Early Head Start programs establish and implement their school readiness goals. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB number for this collection is 0970-XXXX and expires XX/XX/XXX.