Appendix G6

STUDENT ASSENT PREPAY+30 DOLLARS

OMB Control Number 1850-0882. Expires: 01/31/2015

On [DATE], I spoke with [TI NAME] on the telephone. My parents and I agreed to be in the NLTS
2012.

This is a voluntary research study. Its full name is the National Longitudinal Transition Study 2012. The
Department of Education is paying for this study. Mathematica Policy Research, Inc. is carrying it out. I
am one of 18,000 middle and high school students across the United States in the study.
The purpose of the research is to see what helps students move from school to adulthood. People
who run schools hope that all students will leave school prepared for the future. Data from this
study will be used to improve the ways schools help students become productive adults.
All the information I give the researchers or they find out from others or from records will be
completely confidential. It will not be shared with anyone in my school or home. Only researchers
can see my information. In accordance to federal law, any data files used to write reports will be
for researcher use only and will fulfill privacy regulations and guidelines set by the National Center
for Education Statistics. Information about me will be combined with information about other
students in the study. My name will never be used. All reports will be written only in a summary
form, and will not refer to any individual.
Being in the study means:


An interviewer asked me questions on the telephone for about ½ hour. We talked about me,
school, and my plans for the future. This interview was recorded for quality control purposes. An
interviewer will talk to me again in 2014. My parent or guardian can help me answer questions
or answer for me. I will get a $10 gift card each time I do an interview.



The interviewer also talked to my parent or legal guardian for about 30-35 minutes. The
questions were about my family, experiences, and supports I get from school and other places.
This interview was recorded for quality control purposes. They will be interviewed again in 2014.
They will be paid $5 before and $30 after each interview they do.



If I am around 16 to 18 years old in 2014, I may take a special test called an academic
assessment. This test is for the study and will not count towards any of my classes in school. If I
am in school, the test will take place during school. If not, the researchers will make an
appointment for me to take the test outside of school. The test will take between 15-45
minutes.



The researchers will also look at my school transcripts to see what courses I have taken. They
will do this in 2014.

CONTINUES ON BACK →



They will want to see how I am doing in the future. They may want to combine data from my
survey with other information such as data on college enrollment, financial aid for college,
vocational rehabilitation agency services, or the Social Security Administration’s records about
jobs or benefits.



The researchers will learn more about my school by asking my school principal to do a web
survey. If I agree, the researchers will also ask my mathematics or language arts teacher to do a
web survey to learn more about my classes.



If I have an IEP and I agree, the researchers will ask the school staff member who knows the
most about it to do two web surveys to learn about my IEP. One will be now and another will be
two years from now.
o If I am not 18 years old yet, or if I have a legal guardian, my parent or legal guardian agreed
for me to be in this study. Even if my parent or legal guardian agreed, I can decide whether I
want to be in this study or not. When I turn 18 or no longer have a legal guardian, I must
agree again, for myself.
o Being in this study will not benefit me personally, but it will help the Department of
Education plan better programs for youth as they leave high school.
o There are no special risks to me if I take part in this study. If I feel uncomfortable answering
any of the interview questions, I can stop and nothing bad will happen to me. If I change my
mind, nothing bad will happen to me.
o I can ask questions or drop out of the study at any time by calling Anne Ciemnecki at
Mathematica. Her number is 1-866-764-7962. There is no charge for this call. If I have any
questions about my rights as a research volunteer, I can call the New England IRB at 617243-3924. This is the Institutional Review Board. They make sure my rights as a person in
this study are protected.
o There may be another phase of this study in the future and I may be asked to participate
again after 2014. I can decide to participate or not at that time. 1

1

This form will list only the items the parent consented to and the child assented to. Mathematica will track components of
the study that either the parent or the child did not agree to.
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. Public reporting burden for this collection of information is estimated to average 30 minutes per principal response, 30-35 minutes per parent, 30
minutes per each student, and 30 minutes per teacher for each of his or her selected students, and 30 additional minutes per each student aged 16-18 in 2014. This
includes time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. The obligation to respond to this collection is voluntary. Send comments regarding the burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to Yumiko Sekino at 555 New Jersey Ave NW, Washington DC, 20208 or email [email protected]
and reference OMB Control Number. Note: Please do not return the completed data forms to this address.