School Administrator Survey - Consent

Form Approved

OMB No. 0920-xxxx

Exp. Date xx/xx/xxxx

School Administrator Survey Consent – Online Survey

The Presidential Youth Fitness Program (PFYP), the Centers for Disease Control and Prevention (CDC), the Robert Wood Johnson Foundation and ICF International to evaluate the impact of the program at your school. [PYFP SCHOOLS: As a school administrator who works at a school participating in the PYFP, we are interested in learning about your experiences implementing the program and would also like to learn more about physical education and physical activity at your school.] [Non-PYFP SCHOOLS: Although your school has not participated in PYFP program, your school shares many characteristics with a PYFP school participating in the evaluation. We are asking you to complete this survey because we are interested in learning PE and physical activity policies and practices your school. This will allow us to assess the impact of the PYFP program compared with a traditional PE program.

This evaluation, and your participation in it, will help inform program improvement. Participation in this survey is voluntary and your responses will be kept confidential. You can leave blank any survey questions that you do not feel comfortable with or that you do not wish to answer. You can stop at any time.

You will get no benefit right away from taking part in the survey. But the results of this survey will help the PYFP program and other PE teachers in the future.

You can call Isabela Lucas, Project Manager for the PYFP Evaluation, at ICF International at 404-592-2155 with any questions or comments. If you have any questions about your rights as a participant in this program evaluation, you may contact {ENTER IRB CONTACT} at [NUMBER] or [EMAIL].

Clicking on the “Next” button indicates that:

• You have read the above information

• You voluntarily agree to participate

• You are 18 years of age or older