Informed Consent Form

Appendix D: Text Ed Study
EOC Client Information to Update via the Text Ed Technology Platform
(to be completed by EOC staff)

Directions for EOC staff: Please review the information for each EOC client that has been assigned to receive messages from Text Ed and update any fields with new information you have learned about clients directly in the Text Ed platform. This includes any known changes to their college application status and intentions, financial aid application status, and cell phone number.

Client Name (Clients in the Treatment Group Only)

Identified where to apply? (Y/N)

Where client is applying (College name)

Applied? (Y/N or Not Applicable)

Accepted and plans to enroll? (Y/N or Not Applicable)

Intended enrollment date (MM-DD-YYYY)

Submitted FAFSA? (Y/N)

Received Student Aid Report? (Y/N)

Plan to work and go to school at the same time? (Y/N)

Children for whom you are a caretaker? (Y/N)

Cell phone number (XXX-XXX-XXXX)

EOC staff assigned to work with client (Drop-down menu of EOC staff names)

Last Updated (time stamp provided by tech platform)

Jane Doe

Y

Diablo Valley Community College

Y

N

09-01-2019

Y

N

Y

Y

555-444-3333

Gary M.

3/12/2018

John Doe

N

N/A

N/A

N/A

09-01-2020

N

N

Y

N

555-222-1111

Rosie H.

2/4/2018

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is XXXX-XXXX. The time required to complete this information collection is estimated to average 20 minutes biweekly, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collected. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Education, 400 Maryland Ave., SW, Washington, DC 20210-4537 or email [email protected] and reference the OMB Control Number XXXX-XXXX.

OMB NO.:
 EXPIRATION DATE:

Notice of Confidentiality

Information collected for this study comes under the confidentiality and data protection requirements of the Institute of Education Sciences (The Education Sciences Reform Act of 2002, Title I, Part E, Section 183). Responses to this data collection will be used only for statistical purposes. The reports prepared for the study will summarize findings across the sample and will not associate responses with a specific Education Opportunity Center (EOC) grantee or individual. We will not provide information that identifies you or your EOC to anyone outside the study team, except as required by law.