Consent to participate in research evaluation of school program Make It Happen

Purpose and Background

Dr. Christine Yeh, Mariana Chavez, Todd Bittle, and Stephanie Khaziran are collaboration an
evaluation investigating students impression of and involvement in a college knowledge and
access program, called Make It Happen. They seek to understand what students find helpful and
not so helpful in this program. They also want to see if students who participates in this program
are more engaged in school, more confident in seeking academic help, more connected to peers,
and more confident in learning about college. In addition, they will assess whether or not, this
program helps students perform better socially and academically.

Procedures
Your child will fill out a survey asking questions about their participation before and after the
group. The survey will take about 15 minutes to complete. Your child can decline any questions
at any time, and it will not affect their participation in the program. The questions relate to your
childs reaction to various aspects and components of the program, and their overall experience
in school and with peers.

Risks and/or Discomforts

Records will be kept as confidential as is possible. No individual identities will be used in any
reports or publications resulting from the study. Study information will be coded and kept in
locked files at all times. Only study personnel will have access to the files.

Benefits
The anticipated benefit of this study is the contribution in understanding how the college access
program may be contributing to your childs academic, social, and career development.

Questions
If you have any questions about the evaluation, you may contact Dr. Christine Yeh at 415-422-
2347.

Consent
Participation in the research part of the program is voluntary. You are free to decline to have
your child be in this study, or to withdraw your child from it at any point. To decline
participation, you may contact Dr. Yeh at 415-422-2347. Your child will still be in the program.
If you do not want your child to participate, please do not complete the consent form.
 Consent Form

My name is Melody Wong and I am a graduate student in the School Counseling Program,
pursuing my MA in Counseling Psychology with a concentration in School Counseling and Pupil
Personnel Services Credential at University of San Francisco. My direct supervisor at Balboa
High School is Michael Mar, MS PPSC, School Counselor. In order to provide you with the best
services possible, I will be meeting with site supervisor on a regular basis to plan for the
implementation for this Make It Happen project- which entails data collection, group sessions
discussing student goals, resume building, learning new organizational skills, coping skills, etc.
If you have any questions or concerns regarding the services I am providing to you, you are
welcome to contact my direct supervisor (marm@sfusd.edu) or myself at
(wongm2@sfusd.edu). I am required to have direct supervision of my counseling services and
cannot provide services without this supervision.

By signing this form, it indicates that you acknowledge that you have been given the above
information, and give permission for your child to participate in the Make it Happen series.

The series will take place for 8 weeks during homeroom and lunch on Wednesdays. The first day
will begin on October 4, 2017.

Your Rights: You may refuse to sign this form. You may cancel or withdraw it at any time by
informing the myself or my direct supervisor. If you cancel your permission to allow your child
to participate, it will go into effect immediately. You have a right to receive a copy of this
Authorization.

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Parent/Guardian Signature Date

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Parent/Guardian Name Date

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Student Name Date