Pre-Post School Staff and District Climate Interview Consent Form

Form Approved

OMB No. 0920-0840

Expiration Date: 07/31/2024

LGBTQ Inclusivity Toolkit Demonstration Project

Pre-Post School Staff and District Staff Climate Interview, District Staff Consent Form

LGBTQ Inclusivity Toolkit Demonstration Project

Pre-Post School Staff and District Staff Climate Interview

District Staff Consent Form

Thank you for agreeing to meet with us today. I am ________ and my pronouns are ________. I work for a company called ICF. We are working with the Centers for Disease Control and Prevention’s (CDC) Division of Adolescent and School Health (DASH) to develop an LGBTQ inclusivity toolkit. LGBTQ stands for Lesbian, Gay, Bisexual, Transgender, Queer/Questioning. This toolkit contains a district self-assessment to help districts identify gaps in their current inclusivity strategies and it also provides information, resources, and suggestions for districts and schools to strengthen their existing and implement new LGBTQ inclusivity strategies. We are conducting these interviews to learn more about how this toolkit can be most useful to you, and to help you understand your district’s current climate as related to LGBTQ inclusivity.

Participating in the interview today is voluntary. You may receive an invitation to participate in a second interview at a later time as we continue the toolkit evaluation. Participation in the second interview is voluntary and would not be connected to your participation in the first interview.

Before we begin, I would like to review a few points about the interview and confirm whether you would still like to participate. These points are also reflected on the copy of the consent statement that I gave you:

• This interview is completely voluntary. You do not have to take part in this interview. Whether or not you take part in this project will not affect your job.

• With your permission, we will audio-record the interview. 

• Your name will not be linked with the notes or audio recording from this interview. No quotes or comments you make will be linked with your name or other personally identifiable information (e.g., your email address) in any way. Your name will not be used in any publications or reports about these interviews. 

• We will only share overall findings from these interviews, and we will protect your identity as a respondent. 

• The information collected in these interviews will be used to help inform the creation of the toolkit and to inform your district about the current climate related to LGBTQ inclusivity.

• You may choose to stop participating in the interview at any time, including skipping certain questions or sections you wish not to answer.

• We expect this interview to take no more than 60 minutes. You will receive a $25 gift card to thank you for participating in this interview. If you decide to stop the interview before we ask all of the questions, you will still receive the gift card.

In order for this process to be useful to your district, it is important that you describe the district climate as it really is, and not how it is “supposed to be.” We would like to learn about all aspects of the district climate as it is now – as well as areas in which changes are being implemented or not – so that we have a basis for comparing changes that occur over time in your district.

If you have any questions about the survey or your rights as a participant in this study, you may contact Lisa Carver, ICF Project Manager, at [email protected], or the ICF Institutional Review Board attn. Christine Walrath, at 646-695-8154.

Do you agree to participate?  YES  NO 

Do I have your permission to record the interview?  YES NO 

If yes, continue: Thank you. 

***TURN ON RECORDER***