3245-0394 Appendix A-3 Survey Consent Form 12-05-2022

Evaluation of the T.H.R.I.V.E. Emerging Leaders Reimagined

3245-0394 Appendix A-3 Survey Consent Form 12-05-2022

OMB: 3245-0394

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Consent Form

The U.S. Small Business Administration’s (SBA’s) Office of Entrepreneurial Development (OED) is conducting an evaluation of the T.H.R.I.V.E. Emerging Leaders Reimagined program. The survey has been designed to learn about the program participants, their businesses, and their experience with the program. The objective of this evaluation is to determine if the program is meeting its intended business growth outcomes.


SBA’s contractor for this evaluation, Optimal Solutions Group LLC, will collect and store your responses to this survey on a secure server accessible to Optimal Solutions Group staff only. Your responses will be kept strictly confidential, and your name will never be used in any reports produced for this evaluation. All survey responses will be presented as aggregated statistics in form of averages, percentages, and frequency counts. All survey responses will be de-identified and then these data will be provided to the SBA.


The SBA want to hear your voice and learn about your experiences with the program. Your opinion and feedback are important for the SBA’s efforts to improve its services to America’s small businesses. The evaluation results are expected to provide suggestions for improvements to this valuable small business assistance program.


The estimated burden for completing this survey is less than 20 minutes. You will need your past year's financial information, including revenue, profits, and number of employees available to complete the survey.

Your participation in this survey is completely voluntary. You have the right to not participate. You can stop participating at any time and you do not have to answer any questions that you do not want to.


Optimal Solutions Group LLC will collect and store your responses to this survey on a secure server accessible to Optimal Solutions Group staff only.  Any information provided in this survey will be kept confidential. No respondent will be identified or named in any publicly available report or other such publication. All survey responses will be presented as aggregated statistics in the form of averages, percentages, and frequency counts. All survey responses will be de-identified and then these data will be provided to the SBA.



  • If you have questions about this study, please contact Joann Braxton at SBA, (202) 539-1429, [email protected].

  • If you have questions about your participation in this study, please contact Oswaldo Urdapilleta at Optimal, (301) 306-1170 Ext. 709, [email protected]


If you understand the information presented in this consent form and would like to participate in the survey, please check the appropriate box below:


  • I consent

  • I do not consent (SKIP THE SURVEY)


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorAndrey Vinokurov
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