Cognitive Interviews for High School Longitudinal Study of 2009 (HSLS:09) Student and Parent Survey Draft Items

High School Longitudinal Study of 2009 First Follow-up (HSLS:09)

2010 Cognitive Interviews

Attachment III

Participant Information Sheet

Student Cognitive Interview Participant Information Form

Thank you for participating in a cognitive interview. Prior to beginning, please provide the following information about yourself. This information is requested so that we can learn about the interview participants. 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 purpose except as required by law [Education Sciences Reform Act of 2002 (ESRA 2002) Public Law 107-279, Section 183].

Completing this information is strictly voluntary on your part.

Grade in High School: ____________ Gender: ₁ Male ₂ Female

Are you of either Hispanic or Latino origin?

₁ Yes

₂ No

What is your race? (Please check one or more.)

₁ American Indian or Alaska Native
₂ Asian
₃ Black or African American
₄ Native Hawaiian or Other Pacific Islander

₅ White

Thank you for providing this information.

Parent Cognitive Interview Participant Information Form

Thank you for participating in a cognitive interview. Prior to beginning, please provide the following information about yourself. This information is requested so that we can learn about those participating in the interview. 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 purpose except as required by law [Education Sciences Reform Act of 2002 (ESRA 2002) Public Law 107-279, Section 183].

Completing this information is strictly voluntary on your part.

Gender: ₁ Male ₂ Female

Are you of either Hispanic or Latino origin?

₁ Yes

₂ No

What is your race? (Please check one or more.)

₁ American Indian or Alaska Native
₂ Asian
₃ Black or African American
₄ Native Hawaiian or Other Pacific Islander

₅ White

Thank you for providing this information.