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ATTACHMENT
A2
PARTICIPANT
RECRUITMENT FORM
OMB
No:
Expiration
Date: Head
Start Family Voices Pilot Study
Participant
Recruitment Form
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Program:
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Interview
Type: [pre-fill
early head start or head start]
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Address:
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Phone:
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City:
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State:
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Fax:
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Instructions
Confirm
all pre-filled contact information for your program. Indicate any
special considerations in the box located on the top of page 2,
including specific program requirements or requests.
Complete
the proposed interview schedule on page 2. Based on the
information shared with us by your program, we have indicated the
number and characteristics of participants we would like to
interview from your program. We will complete half of the
interviews in person (Box A), and the other half by phone (Box
B). Information on the number of parents to be interviewed from
each program option (home-based or center-based) has been
pre-filled. We have also indicated which interviews we would like
to complete in Spanish. Please do not change any of the
pre-filled information unless you have discussed it with us
first.
Please
consider the following in identifying staff and parent
participants:
If
your program provides both Early Head Start and Head Start
services, we would like for you to only recruit staff and
parents in [pre-fill
early head start or head start].
Please
distribute two
copies of the consent form to staff and parents who agree to
participate. Have them sign and return one copy. The other copy
is theirs to keep.
Participating
staff will include home visitors/educators, as well as family
services staff (which may include family service workers, family
services managers, and family services coordinators).
We
would like to interview parents with different types of needs.
Please recruit at least one parent in each of the following
groups: [pre-fill
based on screener]
teen mothers, single-parent families, families who live in
transitional housing or may be homeless, and parents who may
have mental health problems. [include
only if program offers early head start services]:
We would also like to interview at least one parent who is
enrolled in the program because she is pregnant.
We
also want to interview parents who are challenging to engage in
the program, and those who engage more readily.
Return
the completed form, along with signed copies of staff and parent
consent forms, to your Mathematica Coordinator no later than
[date].
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Mathematica
Coordinator:
Name:
Address
1:
Address
2:
Phone:
Fax:
Email
address:
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On-Site
Coordinator:
Name:
Position/Title:
Address
1:
Address
2:
Phone:
Fax:
Email
address:
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Mathematica
Field Interviewer:
Name:
Address
1:
Address
2:
Phone:
Fax:
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Interview
Location:
Address
1:
Address
2:
Phone:
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Interview
Schedule
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box
a. interviews to be completed in-person
from
[pre-fill in-person interview window]
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Participant
Name
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Participant
Type
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Language
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Interview
Date/Time
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Interview
Location
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box
b. interviews to be completed by
phone
[pre-fill phone interview window]
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Participant
Name
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Participant
Type
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Language
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Interview
Date/Time
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Telephone
Number
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File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Eileen Rodriguez |
File Modified | 0000-00-00 |
File Created | 2021-01-29 |