10 Web Survey Consent Form

Evaluation of the Minnesota Reading Corps

Member Baseline Web-Survey Consent Form

SCREEN #1

Login Page:

Please enter the User ID and password where indicated below. You will be prompted to re-enter the password a second time to ensure it is correct. Then select the “Continue" button to access the survey.

IMPORTANT: Your password is CASE SENSITIVE and will not let you login without proper UPPER and LOWER CASE letters. Please keep a record of your password since you will need to enter it again below to indicate your consent to complete the survey.

Thank you for taking the time to complete the survey.

Please enter your User ID: Please enter your Password:

If you have any issues accessing the survey, please contact the study at 877-XXX-XXXX or send an e-mail to [email protected].

SCREEN #2

Welcome to the Minnesota Reading Corps Evaluation Survey, and thank you for your willingness to participate. This survey, conducted by NORC at the University of Chicago (NORC) on behalf of the Corporation for National and Community Service (CNCS), will generate valuable information on the types of people who are applying to the MRC program, why applicants want to serve as tutors, and what they might do after the program.

The survey is part of a larger study that seeks to understand more about the MRC and how it affects students who receive the tutoring, as well as how it might affect the tutors themselves. Your participation in the survey will assist us in learning the outcomes of becoming an MRC literacy tutor such as increased instructional skills in literacy interventions, the pursuit of educational-related careers, and increased civic engagement. The information you provide will also be used to better understand the needs and experiences of people like you. Completing this survey will take approximately 20 minutes of your time.

Consent Page:

Under contract with the Corporation for National and Community Service (CNCS), NORC at the University of Chicago seeks to obtain information from applicants who apply to the Minnesota Reading Corps program. You are being asked to participate in this important study, the Evaluation of the Minnesota Reading Corps Program.

The information collected in the questionnaire is being requested by NORC and your data is protected under the Privacy Act of 1974 as amended. Under this Act, NORC is required to treat all information you provide as confidential. The information you provide will be used only for the purpose of analyzing data and preparing scientific reports and articles. Any information publicly released (such as statistical summaries) will be in a form that does not personally identify you. Your individual information will not be shared with the Minnesota Reading Corps or CNCS.

Your participation will be used to assess and identify areas for possible improvement to the Minnesota Reading Corps program. The information you provide will also be used to better understand the needs and experiences of AmeriCorps member applicants like you. Your response is voluntary and failure to provide some or all of the requested information will not in any way adversely affect you. Actual time to complete the questionnaire may vary depending on your circumstances. On average, it will take approximately 20 minutes.

An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a current valid OMB Control Number. The OMB Control Number is xxxx-xxxx for this study and approval expires on xx/xx/xxxx.

If you have any questions or comments regarding this study, you may refer to the Frequently Asked Questions at INSERT LINK TO Project Website where FAQs are listed. For a detailed description of the study, you may refer to the Project Description at INSERT LINK. If you have further questions, please contact the study at 877-XXX-XXXX or send an email to [email protected]. For information on your rights as a research subject, please call the NORC Institutional Review Board administrator at 1-866-309-0542.

Again, thank you for your time and effort in completing this very important study on the Evaluation of the Minnesota Reading Corps Program.

Please enter your password once again to indicate your consent, and press the "NEXT" button to launch the survey.

Our mission is to conduct high quality social science research in the public interest.