Parent Consent Form

Evaluation of the justice AmeriCorps (jAC)
Legal Services for Unaccompanied Children Program
CONSENT FOR CHILD TO PARTICIPATE IN AN INTERVIEW

For young people under 16 years of age who have a parent or legal guardian
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 child’s lawyer works.
WHAT WE ARE ASKING OF YOU
If you agree to allow your child to participate in this study, he/she will be interviewed for about 60
minutes. We will ask questions about his/her understanding of immigration court and what he/she
may have learned from his/her lawyer about his/her legal case. For example, the child will be
asked if he/she has been to immigration court, and what the people in the court do. He/she will be
asked how talking to the attorney may have helped, and what he/she may have learned about
ways children can win their cases and be legally allowed to remain in the U.S. He/she will NOT be
asked about his/her previous migration experiences, your family, other personal issues or anything
bad that may have happened to him/her.
Vera will also collect information about the legal services program from the organization that is
providing your child 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 yours who have lawyers.
KEEPING YOUR INFORMATION PRIVATE
The information Vera collects about your child will be kept private. No personal identifying
information, such as your child’s name or specific details of your child’s 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 child’s name will not
be kept with notes from the interview. Nothing from the interview with your child’s name will be
shared outside of team working on this project.
We may have to tell the authorities, if your child says any of the following:
1) information about committing a crime,
2) your child is going to harm himself/herself, or
3) he/she 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 your child 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 child’s name or any specific details about your child. It will only cover general information
from all the interviews. Information about your child will be destroyed once we write the report.
Vera expects this study to end by September 28, 2016.
YOU DO NOT HAVE TO PARTICIPATE
Your child does not have to talk with us. Participation in this study is completely voluntary. Your
child will continue to receive legal services no matter what you decide. Your decision to allow your
child to participate or not participate will not affect your child’s legal case or result in any special
benefit or loss of benefit to your child. Vera will not tell anyone what you decide. If you decide to
allow your child to be interviewed, your child may still refuse to answer any question he/she does
not want to answer. Your child may also decide to stop participating at anytime.
RISKS
There are some risks that Vera tries to make sure do not happen, but you and your child should
know what they are before you agree your child can talk with us.
1) There is a small risk that some questions asked during the interview will make your child
feel upset or uncomfortable. Remember that your child does not have to answer those
questions. Your child can skip the questions, take a break or stop at anytime.
2) There is a very small chance that information about your child could be accidentally
disclosed to someone outside the evaluation team. However, this is unlikely to happen
because Vera will take precautions to keep your child’s information out of sight in locked
cabinets and in secure computer files.
3) We want to talk with your child in a private room, but there is a risk that what your child
says 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 your child does want repeated.
Information about your child 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
Your child will not receive any direct benefit by participating in this study. The researchers from
the Vera Institute cannot advocate on your or your child’s behalf. However, what your child
says may help us learn how to improve the legal services available to unaccompanied children.
Because we appreciate your child’s willingness to be interviewed, your child will receive a gift
card in the amount of $25 for his/her 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 90 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 or your child 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
212-376-3168
WHAT YOU NEED TO KNOW BEFORE YOU AGREE
1. YOUR CHILD DOESN’T HAVE TO DO THIS.
2. YOUR CHILD’S NAME WILL NOT BE USED IN ANY REPORT.
3. YOUR CHILD 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 and your child a copy of the information just read to you.
CONSENT FOR YOUR CHILD TO PARTICIPATE IN INTERVIEW
By allowing your child to talk with us following the reading of this information, you have
consented for your child to participate in the interview. If you do not agree and have
decided you do not want your child 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