HBCU letter and consent form

Letter/E-mail of Invitation to Nominated Administrators

FROM: Carmen Arroyo, PhD

American Institutes for Research

[email protected]

RE: Survey to Determine the Efforts of Historically Black Colleges and Universities to Eliminate Health Disparities

DATE:

The American Institutes for Research (AIR) has been contracted by the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HHS/HRSA), Office of Minority Health to conduct an assessment of the engagement of Historically Black Colleges and Universities (HBCUs) in campus and community-based activities designed to eliminate health disparities among African Americans.

We have identified four broad categories of activities common among HBCUs, including:

• research and scholarship;

• research infrastructure development;

• campus-based programs aimed at students and/or employees; and

• community outreach and services implemented by HBCU faculty or students.

We will be asking administrators at all HBCUs who are familiar with efforts implemented at their institutions to participate in a survey, which includes questions related to each of these activity areas. The survey is designed to help us uncover and more clearly articulate the types of support that HBCUs provide in these activity areas, and to determine how HRSA may continue to assist HBCUs in their efforts.

We are requesting your participation in this survey. We know that you are very busy in your work and have designed the survey to take no more than 40-45 minutes to complete. You may fill out the paper version of the survey or complete a web-based survey. Enclosed is the paper version of the survey, along with a self-addressed stamped envelop. Also enclosed is login information that will allow you to access the web-based survey. You may complete the entire survey in one sitting or complete parts of the form as time allows and return to it at your convenience. Please note that you only need to complete one version of the survey.

We greatly appreciate your participation in this survey and welcome your input so that we can ensure that we capture the best information possible about efforts underway at HBCUs designed to eliminate health disparities. If you have any questions about the survey, please feel free to contact the Principal Investigator for this project, Carmen Arroyo, [email protected].

Letter/E-mail of Invitation

FROM: Carmen Arroyo, PhD

American Institutes for Research

[email protected]

RE: Survey to Determine the Efforts of Historically Black Colleges and Universities to Eliminate Health Disparities

DATE:

The American Institutes for Research (AIR) has been contracted by the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HHS/HRSA), Office of Minority Health to conduct an assessment of the engagement of Historically Black Colleges and Universities (HBCUs) in campus and community-based activities designed to eliminate health disparities among African Americans.

We have identified four broad categories of activities common among HBCUs, including:

• research and scholarship;

• research infrastructure development;

• campus-based programs aimed at students and/or employees; and

• community outreach and services implemented by HBCU faculty or students.

We will be asking administrators at all HBCUs who are familiar with efforts implemented at their institutions to participate in a survey, which includes questions related to each of these activity areas. The survey is designed to help us uncover and more clearly articulate the types of support that HBCUs provide in these activity areas, and to determine how HRSA may continue to assist HBCUs in their efforts.

We are sending you this request because your name was given to us by an Administrator at your institution. We are requesting your participation in this survey. We know that you are very busy in your work and have designed the survey to take no more than 40-45 minutes to complete. You may fill out the paper version of the survey or complete a web-based survey. Enclosed is the paper version of the survey, along with a self-addressed stamped envelop. Also enclosed is login information that will allow you to access the web-based survey. You may complete the entire survey in one sitting or complete parts of the form as time allows and return to it at your convenience. Please note that you only need to complete one version of the survey.

We greatly appreciate your participation in this survey and welcome your input so that we can ensure that we capture the best information possible about efforts underway at HBCUs designed to eliminate health disparities. If you have any questions about the survey, please feel free to contact the Principal Investigator for this project, Carmen Arroyo, [email protected].

Informed Consent Form

Survey of Historically Black Colleges and Universities (HBCUs) Engagement to Eliminate Health Disparities Consent Form

Purpose

The American Institutes for Research (AIR) has been contracted by the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HHS/HRSA), Office of Minority Health to conduct an assessment of the engagement of Historically Black Colleges and Universities (HBCUs) in campus and community-based activities designed to eliminate health disparities among African Americans.

As part of this study you are being asked to complete a short survey designed to gather information about the types of activities conducted by faculty and students to help eliminate health discrepancy. Specifically, we are interested in learning about the factors that have helped you, faculty, and students on your campus implement activities in each of the following areas:

• research and scholarship;

• research infrastructure development;

• campus-based programs aimed at students and/or employees; and

• community outreach and services implemented by HBCU faculty and students.

Completion of the survey is entirely voluntary. At any time you may ask to have your survey withdrawn from the study and you may choose to discontinue your participation in the survey without penalty.

Risks and Discomfort

No risks are anticipated as result of participation in the survey.

Benefits

You have been asked to participate in this study because of your depth of knowledge of campus-based policies and initiatives that can potentially foster the development of activities focused on the elimination of health disparities. The information you provide will allow AIR and the HHS/HRSA Office of Minority Health to assess the activities to eliminate health disparities presently being carried out on HBCU campuses and in surrounding communities. The information will also be used to develop technical assistance to assist other HBCUs in the implementation of similar activities designed to eliminate health disparities.

Data Protection

All survey information will be used for research purposes only by the Department of Health and Human Services, Office of Minority Health and the AIR research team. Although we ask that you specify your name and the name of your institution both within this consent form and at the time you complete the survey, this information is being gathered only to help us track responses; it allows us to know which institutions are represented within the completed surveys and which ones may require additional follow-up. Once we receive a completed survey from you, all identifying information, including your name and the name of your institution, will be removed from our dataset and will not appear on reports that stem from data collected through the survey.

More Information

If you have questions about this study please contact Dr. Carmen Arroyo at (202) 403-5904. For questions regarding your rights as a human subject participating in this research, contact Doug Gibson at (202) 342-5052.

Informed Consent

• If you are completing the paper version of the survey: If you have read and understood the information above and agree to voluntarily participate in this research please sign below. Please return completed informed consent forms in the self-addressed stamped envelopes provided or mail to this address:

<<Supply address>>

• If you are completing the web-based version of the survey: please keep this form for your records. Upon login, you will be prompted to read and electronically sign an informed consent form.

Print Name: __________________________________________________________

First Last

Signature: _____________________________________Date___________________

College/University: ____________________________________________________

4