School Counselor Log

Consent Form

Dear School Attendance Counselor:

The Attendance Messaging Project is a new study designed to test an innovative text messaging system that provides information to parents about their children’s attendance. Your participation is important and appreciated, but you do have the right to skip any question that you do not wish to answer.

The purpose of this log is to document the amount of time you have spent working with families on issues related to their child’s school attendance. The time allocations will help the researchers, school district and school personnel, and text message vendors understand the added costs of certain messaging strategies that are part of the Attendance Messaging Project. Below are answers to some general questions concerning your participation.

Who is collecting this log?

The Attendance Messaging Project was commissioned by the Department of Education’s Institute of Education Science and this log is administered by American Institutes for Research.

Will my responses be kept confidential?

Your responses are protected from disclosure by federal statute (P.L. 107-279, Title I, Part E, Sec.183). All responses that relate to or describe identifiable characteristics of individuals may be used only for statistical purposes and may not be disclosed, or used, in identifiable form for any other purposes, unless otherwise compelled by law.

The information you provide will be combined with the information provided by others in statistical reports. No individual data that link your name or email address with your responses will be included in the study reports.

Is it possible to withdraw participation?

Participation is voluntary; therefore, refusal to participate will involve no penalty or loss of benefits to which you are otherwise entitled, and you may discontinue participation at any time without penalty or loss of benefits to which you are otherwise entitled.

Who should I contact if I have questions?

If you have questions about the log or the Attendance Messaging Project, please contact Seth Brown at sbrown@air.org or 202-403-5959. If you have concerns or questions about your rights as a participant, contact the Chair of AIR’s Institutional Review Board (which is responsible for the protection of project participants): IRB Chair at IRBChair@air.org, toll free at 1-800-634-0797, or c/o IRB, 1000 Thomas Jefferson Street, NW, Washington, DC 20007.

Please select begin to start the log.

Begin.

Please check the box below if you do not wish to participate in the log.

I choose not to participate in the log.

Thank you for your cooperation in this very important effort!

School Attendance Counselor Log

Spring 2018

Paperwork Burden Statement

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 is XXXX-XXXX. The time required to complete this voluntary information collection is estimated to average 40 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education, Washington, DC 20202–4537. If you have comments or concerns regarding the status of your individual submission of this form, write directly to: 550 12th street, SW, Washington, DC 20202.

1. Other than your role on the Attendance Messaging Project, what position(s) do you hold this school year (i.e., 2017-18)? Check all that apply.

• No other positions

• Teacher

• School secretary/administrator

• School attendance counselor

• Other school counselor

• Other position in your school

Please specify:_________________________________________

2. During the fall of 2017, was anyone in your school formally responsible for addressing issues related to attendance?

• Yes

• No  skip to question 8

• I don’t know  skip to question 8

3. Was there an individual or a team of people in your school who were formally responsible for addressing issues related to attendance during the fall of 2017?

• An individual  Continue to question 4

• A team of people  Skip to question 5

4. Who was formally responsible for addressing issues related to attendance during the fall of 2017? Please select one.

• I was

• A teacher

• The school secretary

• A school counselor

• The Assistant Principal

• The Principal

• Other, specify: ______________________________________________________

[Conditional logic will direct the respondent to question 8.]

5. Were you part of the team of people who was formally responsible for addressing issues related to attendance during the fall of 2017?

• Yes  Continue on to question 6

• No  Skip to question 7

6. Other than you, who else was part of the team of people responsible for addressing issues related to attendance during the fall of 2017? Check all that apply.

• Teacher(s)

• School secretary

• School counselor

• Assistant Principal

• Principal

• Other, specify: ______________________________________________________

[Conditional logic will direct the respondent to question 8.]

7. Who was part of the team of people responsible for addressing issues related to attendance during the fall of 2017? Check all that apply.

• Teacher(s)

• School secretary

• School counselor

• Assistant Principal

• Principal

• Other, specify: ______________________________________________________

• I don’t know

8. Please indicate whether and how your school used each of the strategies listed below during the 2017-18 school year to address absenteeism. Please consider a strategy to be informal if it is not part of an official plan, or formal if it is part of an official plan.

When thinking about whether your school used each item, please no not count any activities that are happening this year as part of the Attendance Messaging Project.

		Our school did not use strategy	Our school informally used strategy	Our school formally used strategy, but we did not keep track of its implementation	Our school formally used strategy, and kept track of its implementation
a.	Create a welcoming school climate	1	2	3	4
b.	Provide information to parents or guardians about the importance of attendance	1	2	3	4
c.	Assess individual student or family needs that affect attendance and contact parents or guardians as appropriate	1	2	3	4
d.	Use legal means (e.g., courts) to involve families and students in needed services when appropriate	1	2	3	4
e.	Recognize good or improved attendance for classrooms, students, or parents	1	2	3	4
f.	Establish specific attendance goals for students	1	2	3	4
g.	Contact parents by phone or mail when students are absent	1	2	3	4
h.	Make home visits and refer families to appropriate services (e.g. social services, human resources, housing, and health services)	1	2	3	4
i.	Arrange transportation to and from school with other families or staff	1	2	3	4
j.	Invite parents and community members to help address the barriers that keep children from attending school (e.g., health related issues, unsafe neighborhood)	1	2	3	4
k.	Have school staff identify barriers to attendance, such as health, transportation or housing	1	2	3	4
l.	Involve public agencies and community partners and resources as needed to address barriers to attendance	1	2	3	4
m.	Involve the school nurse with follow-up on medical related absences	1	2	3	4
n.	Develop intervention plans with families and monitor for progress	1	2	3	4
o.	Connect students with chronic physical and mental health issues to medical providers	1	2	3	4

9. Please indicate if you reached out to and/or established two-way communication with any of the following students or the families of these students regarding school attendance between January 1, 2018 and January 31, 2018.

Name	Grade	Did you communicate with or try to communicate with this student or his/her family about attendance between January 1, 2018 and January 31, 2018?
Alisa Wain	K	Yes	No
Dwayne Swart	K	Yes	No
Ernst Hyatt	K	Yes	No
Laurie Pavlak	K	Yes	No
Theresa Hinchey	K	Yes	No
Vanessa Neiman	K	Yes	No
Estrella Sproull	1st	Yes	No
Fredericka Hopes	1st	Yes	No
Jennefer Suman	1st	Yes	No
Johnsie Lashley	1st	Yes	No
Mariah Biel	1st	Yes	No
Shirly Goncalves	1st	Yes	No
Angeline Fenimore	2nd	Yes	No
Calvin Kissinger	2nd	Yes	No
Christa Scicchitano	2nd	Yes	No
Franchesca Brendel	2nd	Yes	No
Louise Saam	2nd	Yes	No
Steffanie Vela	2nd	Yes	No
Alesia Thacker	3rd	Yes	No
Dominique Buchan	3rd	Yes	No
Francisco Stilwell	3rd	Yes	No
Isabell Watt	3rd	Yes	No
Kacy Cordle	3rd	Yes	No
Kary Speight	3rd	Yes	No
Bethel Kreps	4th	Yes	No
Brain Tann	4th	Yes	No
Christi Buckler	4th	Yes	No
Elmer Chittum	4th	Yes	No
Evette Ramaker	4th	Yes	No
Keturah Campana	4th	Yes	No
Emery Ketterman	5th	Yes	No
Gearldine Ranson	5th	Yes	No
Ninfa Escamilla	5th	Yes	No
Normand Beuller	5th	Yes	No
Shizuko Reddin	5th	Yes	No

[Questions 10 and 11 will only be asked for students whom the attendance counselor selected “Yes” in Question 9]

10. Between January 1, 2018 and January 31, 2018, approximately how much time (in minutes) did you spend communicating or trying to communicate with the students or the families of these students regarding school attendance?

Please enter the number of minutes per box.

Student	One-on-one discussion with student	Emailing or writing letters to family member	Text messaging family members	Meeting with family members (formal, or unscheduled), in-person or by phone	Other	Please specify for “other”
[Student #1]	__ __ __	__ __ __	__ __ __	__ __ __	__ __ __	_________
[Student #2]	__ __ __	__ __ __	__ __ __	__ __ __	__ __ __	_________
[Student #3]	__ __ __	__ __ __	__ __ __	__ __ __	__ __ __	_________
[Student #4]	__ __ __	__ __ __	__ __ __	__ __ __	__ __ __	_________
…	__ __ __	__ __ __	__ __ __	__ __ __	__ __ __	_________

11. Please indicate whether you informed or directed (e.g., through a conversation, text, email, or letter) any of the students or the families of the students to services provided by the district or the community between January 1, 2018 and January 31, 2018.

For each student, mark all that apply.

Student	I did not inform or direct this student to any district or community service	Transport-ation services	District-provided student services	Social welfare services	Breakfast / lunch programs	Family court / truancy	Other: Specify
[Student #1]	0	1	2	3	4	5	___________
[Student #2]	0	1	2	3	4	5	___________
[Student #3]	0	1	2	3	4	5	___________
[Student #4]	0	1	2	3	4	5	___________
…	0	1	2	3	4	5	___________

American Institutes for Research OMB Clearance Request: Attendance Counselor Log—15