Parent Consent Clean

Agreement to Participate in the National Guard Youth ChalleNGe Job ChalleNGe Evaluation

Your child is invited to be part of the National Guard Youth ChalleNGe Job ChalleNGe Evaluation. This form explains what it means for your child to be in the study. To allow your child to join the study, sign your name at the end of the form.

What is the National Guard Youth ChalleNGe Job ChalleNGe Evaluation?

It is a study to learn more about the Youth ChalleNGe and Job ChalleNGe programs and the outcomes of the youth they serve. The study is run by three organizations: Mathematica Policy Research, MDRC, and Social Policy Research Associates. The U.S. Department of Labor is sponsoring the study.

Who can be in the study?

Every Youth ChalleNGe participant can be in the study.

What does it mean to be in the study?

The study team will collect information on your child from several sources:

• Background Information Form. It will collect information such as address, phone number, social media accounts, and questions on your child’s education and involvement in the juvenile/adult criminal justice system.

• Participation in discussion groups. A small group of particiants will be asked to speak with evaluation staff in a group setting. Questions will be asked about what it was like to get into the Youth ChalleNGe program, experiences in the pre-ChalleNGe part of the program, the activities and help your child receives as part of Youth ChalleNGe, and involvement in mentoring.

• Program and government records. These records may include information from the National Guard Bureau about your child’s program activities. They may also include information at state and federal agencies about your child’s employment and earnings, education, and involvement in juvenile and adult criminal justice systems.

• Interview or survey. You may be asked to participate in individual interviews or complete a survey. Your child will receive a payment for taking the survey. Your child does not have to do the survey or answer any questions that make him/her uncomfortable.

How will the study use my child’s information?

The study team will use your child’s information for research purposes only, to learn about how these programs work and how they may help people. The team will follow strict rules to protect your child’s privacy. Your child’s information will be kept private and confidential. Your child’s name will never be used in any report written for the project. To help us protect your child’s privacy, we have obtained a Certificate of Confidentiality from the National Institutes of Health. The researchers can use this Certificate to legally refuse to disclose information that may identify your child in any federal, state, or local civil, criminal, administrative, legislative, or other proceedings, for example, if there is a court subpoena. The researchers will use the Certificate to resist any demands for information that would identify your child. However, a Certificate does not exclude the study team reporting to the legally appropriate authorities, information related to potential harm or abuse to you or others. In addition, the government may see your child’s information if it audits Mathematica, MDRC, or Social Policy Research Associates but it, too, will protect your child’s privacy.

What are the benefits and risks of participating in the study?

Your child will help Youth ChalleNGe and Job ChalleNGe programs learn how to provide better services for young people like him/her.

There is a small risk of a breach of confidentiality; however, strong precautions will be taken to protect your child’s information.

Does my child have to be in the study?

No. The decision to be in the study is your choice and your child’s choice. However, only people who are in the study will have a chance to be in the Job ChalleNGe program. Your child may drop out of the study at any time by contacting Mathematica (see below). If your child drops out, the study team still may use the information collected while he/she was in the study.

Statement

• I have read this form and understand the information presented.

• I agree that my child may be in the National Guard Youth ChalleNGe Job ChalleNGe Evaluation.

• I know the decision to be in the study is my choice and my child’s choice.

• I know that my child will have a chance to be in the Job ChalleNGe program.

• I understand my child can drop out of the study at any time.

• I know that the study team will follow strict rules to protect my child’s privacy. My child’s name will never appear in any public document.

• I understand that the study team will get information about my child. The information will come from programs and agencies, as described above.

• I understand that my child’s education records are protected under a federal law called the Family Educational Rights and Privacy Act (FERPA). I further understand that I may waive that protection and give the study team access to my child’s records. I agree to waive my child’s rights under FERPA; the study team can get education records about my child.

• I understand that my child may be contacted to complete an interview or take part in a survey. I know my child does not have to participate in the interview or survey, and if my child chooses to participate, I know he/she does not have to answer any questions that make him/her uncomfortable.

___________________________________________

My Name (Please Print)

___________________________________________

My Signature

_______________________

Date

Questions about the National Guard Youth ChalleNGe Job ChalleNGe Evaluation? You can reach a study team member by phone at 866-XXX-XXXX or by email at [email protected].

Federal Law called the Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99) is a Federal law that protects the privacy of your child’s education records. Generally, schools must have permission from you or your child in order to release your child’s education records. When you sign this form, you will give permission to the study team to get your child’s education records.

Page 2 of 3