East St. Louis School District 189 After-School Program Evaluation Consent Form 21st Century Community Learning Centers School Year 2021-2022
The After-School program that your child attends is evaluated each year to make changes that improve the quality of the program and demonstrate to Illinois State Board of Education (ISBE) and the U.S. government that after-school programs contribute to the well-being of our children. ISBE is interested in knowing if program participants are gaining positive youth development skills such as self-confidence, engagement in school, life skills, positive choices and positive core values, as well as how the program has contributed to improved academic performance and school attendance.
With your permission, your child and others will be asked to complete two brief surveys about what they think of the program and how attending the program has affected them: (1) Metis-developed youth survey and (2) Survey of Academic and Youth Outcomes - Youth (SAYO-Y), developed by the National Institute for Out-of-School Time. The SAYO Y is meant for youth between 4th – 12th grade. The SAYO-Y is administered by United Way of Greater St. Louis and is not required by ISBE. The SAYO-Y will be used primarily for quality improvement purposes. Your child’s participation in the surveys is strictly voluntary. Your child is free to refuse participation or skip questions. Participation in the surveys is not required nor does it affect program attendance in a positive or negative way. Your child’s name will not appear on any survey form or report. All responses are anonymous and will be kept confidential. The only exceptions to this are: if information is revealed concerning suicide, homicide, and/or child abuse and/or neglect - the law requires that these types of information be reported to appropriate agencies. In addition, should any information in this survey be the subject of a court order or lawful subpoena, this program might be compelled to disclose the information.
The evaluation will also collect information from your child’s school and from East St. Louis School District 189, including report cards or transcripts, standardized test data, school attendance data, disciplinary data (i.e., suspensions and office referrals), behavior, and demographic information. In addition, feedback on changes in your child’s classroom behaviors will be collected from their classroom teachers. All identifiable data received will be kept secure and confidential and will be reviewed only by the evaluators. All findings will be reported in aggregate form, in other words, for all students together. Individual responses will never be identified.
If you have any questions about your child’s rights as an evaluation participant, please contact Michael Scuello at (212) 425-8833 or mscuello@metisassoc.com. If you have any questions about the survey or evaluation, please contact Lori Ramsey at (212) 425-8833 or lramsey@metisassoc.com. For questions about the SAYO-Y, please contact Lexie Walsh at (314) 935-4183 or a.r.walsh@wustl.edu. If you wish to have a copy of this form, please contact Dr. Lawrence Tourijigian at (618) 646-3192 or at lawrence.tourijigian@estl189.com.
By signing below I agree that I have read and understood the above evaluation description. For things I do not understand, I have asked for and received a satisfactory explanation. I agree to have my child participate in this evaluation through October 31, 2022, and understand that I or my child can withdraw from participation at any time.