Interview Consent Forms

Recipient Consent Form

Thank you for taking the time to speak with me today. My name is ______ and I will facilitate today’s discussion. My colleague ______ is also joining us to listen and take notes.

Your organization received funding from the Centers for Disease Control and Prevention (CDC) to promote equity and improve health, academic achievement, and well-being of students through a cooperative agreement known as the 2302 Healthy Schools Program, or “2302”. CDC engaged ICF to evaluate the 2302 Healthy Schools Program to better understand how funding, professional development, technical assistance, and resources from CDC have contributed to implementation of project strategies and activities by states, districts, and schools.

The purpose of this interview is to learn more about how your organization provides professional development and technical assistance to help states, districts, and schools implement school health strategies and activities to achieve healthier school environments. Evaluation results will be used to demonstrate the impacts of the 2302 program and improve CDC’s support to recipient organizations, school districts, and schools.

This interview will take about 60 minutes. Participation in this interview is voluntary. You may choose to stop the interview at any time, and you may choose not to respond to any question without penalty of any kind. The information we collect from you and other interviews will be summarized and reported to CDC anonymously. Your name and organization will not be associated with your responses in any reports or publications and will be reported in aggregate. Participation in the interview will cause no risk to you or your organization.

If you have questions about this evaluation, please contact the evaluation team at 2302evaluation@icf.com. For questions regarding your rights related to this evaluation, you can contact ICF Institutional Review Board at irb@icf.com.

Do you consent to participate in the interview?

Do you agree to be recorded?

Before we begin the discussion, do you have any questions for me?

Okay, let’s get started. Feel free to reference the interview guide provided in the meeting appointment for today.

I will start the recording now. [Start recording and transcript]

Priority LEA Consent Form

Thank you for taking the time to speak with me today. My name is ______ and I will facilitate today’s discussion. My colleague ______ is also joining us to listen and take notes.

Your school district receives support from [state recipient organization] through funding from the Centers for Disease Control and Prevention (CDC) to promote equity and improve health, academic achievement, and well-being of students through a cooperative agreement known as the 2302 Healthy Schools Program, or ”2302”. CDC engaged ICF to evaluate 2302 to better understand how funding, professional development, technical assistance, and resources from CDC and funded recipients have contributed to implementation of project strategies and activities by states, districts, and schools.

The purpose of this interview is to learn how your school district and the schools in your district are impacted by the support provided by [state recipient organization] through the 2302 Healthy Schools Program. The results of the evaluation will be used to demonstrate the impacts of the 2302 program and improve CDC’s support to states, districts, and schools.

This interview will take about 60 minutes. Participation in this interview is voluntary. You may choose to stop the interview at any time, and you may choose not to respond to any question without penalty of any kind. The information we collect from you and other interviews will be summarized and reported to CDC anonymously. Your name and organization will not be associated with your responses in any reports or publications and will be reported in aggregate. Participation in the interview will cause no risk to you or your organization.

If you have questions about this evaluation, please contact the evaluation team at 2302evaluation@icf.com. For questions regarding your rights related to this evaluation, you can contact ICF Institutional Review Board at irb@icf.com.

Do you consent to participate in the interview?

Do you agree to be recorded?

Before we begin the discussion, do you have any questions for me?

Okay, let’s get started. Feel free to reference the interview guide provided in the meeting appointment for today.

I will start the recording now. [Start recording and transcript]