Evaluation of the Early Warning and Intervention Monitoring System (EWIMS)

The On-Time Graduation Study
School Survey Consent Form
PURPOSE
The On-Time Graduation Study is being conducted by the Midwest Regional Educational Laboratory at
American Institutes for Research (AIR). It is funded by the U.S. Department of Education, Institute of
Education Sciences and will run from January 2014 through the spring of 2016. The purpose of this
survey is to ask school administrators about their school data culture and how they use student data to
identify and intervene with students who may be at-risk for dropping out of high school.
PROCEDURES
Participation includes an online survey that will take approximately 60 minutes to complete. You can start
or stop the survey at any point and your answers will be saved on the online system.
RISKS AND DISCOMFORTS
There are no known risks for participation. Your participation in this study is voluntary. You will not be
penalized in any way for not participating. If you decide to participate, you may discontinue at any time
without penalty.
CONFIDENTIALITY
You are not required to answer questions that you do not want to answer. Responses will be used only for
research purposes and will be kept strictly confidential. Each participant is assigned a study identification
number in place of their names. The reports prepared for this study will summarize findings and will not
associate responses with a specific school or individual. We will not provide information that identifies
you or your school to anyone outside the study team, except as required by law.
BENEFITS
Your participation will help the U.S. Department of Education better understand how schools use data to
identify and intervene with students who may be at-risk for dropping out of high school.
MORE INFORMATION
Upon completion of the survey, you will receive a $30 gift card. If you have any questions about the gift
cards, please contact Suzanne Stachel at [email protected] or 202-403-5584. For more information about
the study in general, you may contact Dr. Ann-Marie Faria, Project Director, at [email protected] or 202403-5356. If you have concerns or questions about your rights as a participant, contact AIR’s Institutional
Review Board (which is responsible for the protection of project participants) at [email protected], toll free at
1-800-634-0797, or c/o IRB, 1000 Thomas Jefferson Street, NW, Washington, DC 20007.
INFORMED CONSENT
 YES, I have read and understand the information above and I agree to participate in this online

survey.
 NO, I have read and understand the information above and do not agree to participate in this

online survey.


Per the policies and procedures required by the Education Sciences Reform Act of 2002, Title I, Part E,
Section 183, responses to this data collection will be used only for statistical purposes. The reports
prepared for this study will summarize findings across the sample and will not associate responses with a
specific district or individual. Any willful disclosure of such information for nonstatistical purposes,
except as required by law, is a class E felony.