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 project this year. We are asking all students applying to this Upward Bound project to be in this study. If you go through the lottery and do not get into Upward Bound you can still be part of the study. If you agree to be in the study, we will ask you 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, College Board, and ACT records. This information will be used only to compare outcomes for groups of students in Upward Bound with outcomes for groups of students in other programs.

If you agree to be 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. You do not have to agree to be in the study to get into the lottery for this Upward Bound project, but we ask you to return this form in the envelope provided to let us know your decision.

What it Means to Be in the Study

If you have parental permission to be in this study of the Upward Bound program, we ask you to complete the form below. This form will tell us whether or not you agree to be in the study. If you agree to be in the study, we ask you to also complete the survey included with this form and return this form and the survey to us with the parental consent form. We will also ask you some survey questions 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. If you agree to be in the study, we will also obtain copies of your school, College Board, and ACT records in about two years and before you turn 18. We will use these records to describe school attendance, courses taken, grades, and test results (on the PSAT, SAT, AP, ACT, and state tests) for groups of students. 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 and we receive the form showing whether or not you have parental permission to be in the study (and, if you do, whether you also agree to be in the study and return the survey), the study team will use a lottery to pick who will get into in this Upward Bound project and who will not. If you don’t get into the project, you won’t be able to enter an Upward Bound project at another time, but you may enter any other program you qualify for. Whether you decide to be in the study or not, you still have to go through the same lottery to get into this Upward Bound project this year. We really would like 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.

The information we collect regarding your identity, survey responses, and school, College Board, and ACT records will be kept private 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 put in place good security procedures to protect your data, and there are strong criminal penalties for anyone who shares data on students without permission, so the chance of that happening is very small.

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 project 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 under a contract with the Department. The purpose of the study is to learn how Upward Bound helps students succeed in high school and prepare for college. The study is permitted under Section 402H of the Higher Education Act of 1965, 20 U. S. C. 1070a-18. 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 use your name and Social Security Number to obtain some of your school, College Board, and ACT records. In accordance with the Privacy Act (5 U.S.C. Section 552a) and the Institute of Education Sciences confidentiality statute (20 U.S.C. 9573, Section 183), the information gathered on you will be kept strictly confidential and will be used by the Department and its contractors 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 (including the two surveys and the obtaining of your student records as described above)?
	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