Scale-up America Initiative Evaluation Study

(OMB Control Number: 3245-XXXX )

ScaleUp America Initiative

Appendix B-9

Participant Interview Consent Form

The U.S. Small Business Administration (SBA) has contracted Optimal Solutions Group, LLC (Optimal), to develop and execute an impact evaluation for the ScaleUp America initiative. The purpose of this evaluation is to provide a rigorous assessment of key elements of the program implementation and its effects on participants across all eight ScaleUp communities, as well as on each community’s small business ecosystem.

As part of this effort, the Optimal evaluation team is conducting phone interviews with selected participants of each ScaleUp initiative. During the phone interview, the evaluation team aims to collect information on participant impressions of the ScaleUp initiative and the local small business ecosystem, and business success stories regarding participation and the community.

Confidentiality and Usage

During the interviews, the research team will be taking written notes of the conversation, which will be used to develop progress reports submitted to SBA and the final public report. Resulting public reports will not identify interviewees, but may connect the information they provide with the type of business they conduct and the community they come from. The research team will provide the option of going “off-the-record” if requested by the interviewee, in which case the information provided will not be included in any reports or notes sent to SBA.

Storage and Access

The written notes from these interviews will be stored in a secure, password-protected document management system accessible only to the Optimal evaluation team working on this project. The information will be retained for no fewer than 3 years after the completion of this program evaluation.

If you understand and agree with the conditions described here, please scan a signed copy of the consent form and email it to [email protected] or simply reply to this email stating that you read the form and consent to the interview. Your consent grants the evaluation team permission to conduct the telephone interview as described above for the above-referenced study. The research team will not use the information provided for any reason without your permission other than those stated in this consent form.

Signature Date

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