Child Consent Form

Evaluation of the justice AmeriCorps (jAC)
Legal Services for Unaccompanied Children Program
ASSENT TO PARTICIPATE IN AN INTERVIEW
For young people under 16 years of age

WHO WE ARE AND WHAT WE ARE DOING
The Vera Institute of Justice (Vera) is a private nonprofit organization that does research and works
with government and other organizations to improve the justice system. Vera has been asked to
study the Legal Services for Unaccompanied Children Program, and the organizations that provide
those legal services, such as the one where your lawyer works.
WHAT WE ARE ASKING OF YOU
If you agree to participate in this study, you will be interviewed for about 60 minutes. We will ask
questions about your understanding of immigration court and what you may have learned from
your lawyer about your legal case. For example, you will be asked if you have been to immigration
court, and what the people in the court do. You will be asked how talking to your attorney may
have helped you, and what you may have learned about ways children can win their cases and be
legally allowed to remain in the U.S. You will NOT be asked about your previous migration
experiences, your family, or other personal issues or about anything bad that may have happened
to you.
Vera will also collect information about the legal services program from the organization that is
providing you with an attorney and from court records of cases of unaccompanied children who go
through immigration proceedings. The information will be put together with the information we
collect from interviews with children like you who have lawyers.
KEEPING YOUR INFORMATION PRIVATE
The information Vera collects about you will be kept private. No personal identifying information,
such as your name or specific details of your case, will be shared with anyone outside the
evaluation team. Personal information will not be shared with the government, the immigration
judge or other people at this organization. Your name will not be kept with notes from your
interview. Nothing from your interview will be shared outside of team working on this project.
We may have to tell the authorities, if you say any of the following:
1) information about committing a crime,
2) you are going to harm yourself, or
3) you or another child is being abused.
OMB # 1125-XXX (Rev. June 2015)
Vera Institute of Justice
Page 1 of 4
This consent form expires one year from the date noted above.
completed: __________

Vera staff to initial when page is

We will NOT ask you questions about these things.
WHAT WE PLAN TO DO WITH THIS INFORMATION
We are going to speak with about 50 children and use what we learn to find ways to improve the
legal services program for children. At the end of the evaluation, a report will be written and given
to the funder of the program so that they can make the program better. The report will not include
your name or any specific details about you. It will only cover general information from all the
interviews. Information about you will be destroyed once we write the report. Vera expects this
study to end by September 28, 2016.
YOU DO NOT HAVE TO PARTICIPATE
You do not have to talk with us. Participation in this study is completely voluntary. You will
continue to receive legal services no matter what you decide. Your decision to participate or not
participate will not affect your legal case or result in any special benefit or loss of benefit to you.
Vera will not tell anyone what you decide. If you decide to be interviewed, you may still refuse to
answer any question you do not want to answer. You may also decide to stop participating at
anytime.
RISKS
There are some risks that Vera tries to make sure do not happen, but you should know what they
are before you agree to talk with us.
1) There is a small risk that some questions asked during the interview will make you feel
upset or uncomfortable. Remember that you do not have to answer those questions. You
can skip the questions, take a break or stop at anytime.
2) There is a very small chance that information about you could be accidentally disclosed to
someone outside the evaluation team. However, this is unlikely to happen because Vera
will take precautions to keep your information out of sight in locked cabinets and in secure
computer files.
3) We want to talk with you in a private room, but there is a risk that what you say might be
disclosed by someone else present at the interview, such as a staff person at the
organization where you receive legal services. For this reason, it is important not share
sensitive information that you do want repeated.
Information about you cannot be demanded (subpoenaed) by the immigration court, because the
information collected in this study is protected by federal law.

OMB # 1125-XXX (Rev. June 2015)
Vera Institute of Justice
Page 2 of 4
This consent form expires one year from the date noted above.
completed: __________

Vera staff to initial when page is

BENEFITS
You will not receive any direct benefit by participating in this study. The researchers from the
Vera Institute cannot advocate on your behalf, however, what you say may help us learn how to
improve the legal services available to unaccompanied immigrant children. Because we
appreciate your willingness to be interviewed, you will receive a gift card in the amount of $25
for your participation.
WHO IS PAYING US TO DO THIS
This evaluation is funded by the Executive Office of Immigration Review (EOIR), U.S. Department of
Justice (DOJ) in cooperation with the Corporation for National and Community Services (CNCS).
PAPERWORK REDUCTION ACT
Under the Paperwork Reduction Act (PRA), a person is not required to respond to a collection of
information unless it displays a valid control number from the Office of Management and Budget.
Under the PRA, forms and instructions are created that are accurate, can be easily understood, and
which impose the least possible burden on you to provide us with information. The estimated
average time to review and complete this collection is 30 minutes. If you have comments regarding
this estimate, or suggestions for making this collection simpler, you can write to the Executive
Office for Immigration Review, Office of the General Counsel, 5107 Leesburg Pike, Suite 2600, Falls
Church, Virginia 20530.
IF YOU HAVE QUESTIONS
If you have questions at any time about this study, you may contact either of the two people below
at the Vera Institute of Justice:
Laura Simich
Annie Chen
[email protected]
[email protected]
212-376-3176
212-376-3137 212-376-3168
WHAT YOU NEED TO KNOW BEFORE YOU AGREE
1. YOU DON’T HAVE TO DO THIS.
2. YOUR NAME WILL NOT BE USED IN ANY REPORT.
3. YOU WILL RECEIVE A GIFT CARD FOR PARTICIPATING.

OMB # 1125-XXX (Rev. June 2015)
Vera Institute of Justice
Page 3 of 4
This consent form expires one year from the date noted above.
completed: __________

Vera staff to initial when page is

We will give you a copy of the information just read to you.
ASSENT TO PARTICIPATE IN INTERVIEW
By staying to talk with us following the reading of this information, you have assented to
participate in the interview. If you do not agree and have decided you do not want to
participate in the interview, you can leave now.

OMB # 1125-XXX (Rev. June 2015)
Vera Institute of Justice
Page 4 of 4
This consent form expires one year from the date noted above.
completed: __________

Vera staff to initial when page is