MOU Template for PCR€¦ · Web viewThis MOU is effective as of the date of the last signing party...

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MEMORANDUM OF UNDERSTANDING THIS MEMORANDUM OF UNDERSTANDING (“MOU”) is entered into and made effective as of the date of last signature below by and between Los Angeles Harbor College (the “College”) and Mathematica Policy Research, Inc. (“Mathematica”) to facilitate Mathematica’s performance of an Implementation and Outcomes Evaluation of the Working Students Success Network (“WSSN”) Initiative under two separate but related contracts with Achieving the Dream (“ATD”) and Rockefeller Philanthropy Advisors, respectively, including any modifications or extensions (the “Evaluation Contracts”). Article 1. PURPOSE AND LEGAL AUTHORITY The WSSN initiative, collaboratively funded by the Annie E. Casey Foundation, Lumina Foundation, W.K. Kellogg Foundation, Kresge Foundation, MetLife Foundation, and Bank of America Charitable Foundation, and managed by ATD, seeks to integrate and expand access to a full range of educational, financial, and career services available to low-income students and students of color. Under the WSSN initiative, 19 community colleges are receiving financial support and technical assistance to offer a variety of services to help students achieve their academic and professional goals, and achieve economic self-sufficiency. The funders have contracted with Mathematica to lead an evaluation of the WSSN initiative (the “Evaluation”). Mathematica will be conducting the Evaluation with its partner, DVP Praxis. The Evaluation includes two key components: (1) formative data collection, analysis, and reporting; and (2) summative data collection, analysis, and reporting. The formative evaluation will inform stakeholders’ efforts to implement the necessary institutional and cultural changes, enhance the supports available to disadvantaged students, and increase the number of students completing community college programs and entering the workforce. The summative evaluation will incorporate administrative and formative data to generate evidence on program

Transcript of MOU Template for PCR€¦ · Web viewThis MOU is effective as of the date of the last signing party...

Page 1: MOU Template for PCR€¦ · Web viewThis MOU is effective as of the date of the last signing party below and shall terminate on the later date of termination of the Evaluation Contracts,

MEMORANDUM OF UNDERSTANDING

THIS MEMORANDUM OF UNDERSTANDING (“MOU”) is entered into and made effective as of the date of last signature below by and between Los Angeles Harbor College (the “College”) and Mathematica Policy Research, Inc. (“Mathematica”) to facilitate Mathematica’s performance of an Implementation and Outcomes Evaluation of the Working Students Success Network (“WSSN”) Initiative under two separate but related contracts with Achieving the Dream (“ATD”) and Rockefeller Philanthropy Advisors, respectively, including any modifications or extensions (the “Evaluation Contracts”).

Article 1. PURPOSE AND LEGAL AUTHORITY

The WSSN initiative, collaboratively funded by the Annie E. Casey Foundation, Lumina Foundation, W.K. Kellogg Foundation, Kresge Foundation, MetLife Foundation, and Bank of America Charitable Foundation, and managed by ATD, seeks to integrate and expand access to a full range of educational, financial, and career services available to low-income students and students of color. Under the WSSN initiative, 19 community colleges are receiving financial support and technical assistance to offer a variety of services to help students achieve their academic and professional goals, and achieve economic self-sufficiency.

The funders have contracted with Mathematica to lead an evaluation of the WSSN initiative (the “Evaluation”). Mathematica will be conducting the Evaluation with its partner, DVP Praxis. The Evaluation includes two key components: (1) formative data collection, analysis, and reporting; and (2) summative data collection, analysis, and reporting. The formative evaluation will inform stakeholders’ efforts to implement the necessary institutional and cultural changes, enhance the supports available to disadvantaged students, and increase the number of students completing community college programs and entering the workforce. The summative evaluation will incorporate administrative and formative data to generate evidence on program participant outcomes by service receipt and student and college characteristics.

This MOU describes in general terms the types of data that the College agrees to provide to Mathematica and the timeframes within which the data will be provided, and establishes the responsibilities of both Parties regarding the disclosure and receipt of these data for purposes of performing the Evaluation.

Under the Family Educational Rights and Privacy Act (“FERPA”), an educational institution may disclose personally identifiable information

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(“PII”) from an education record of a student without consent if the disclosure is to an authorized representative of state or local educational authorities. 34 CFR § 99.31(a)(3). Such authorized representatives may have access to education records in connection with an audit or evaluation of federal or state supported education programs, or for the enforcement of or compliance with federal legal requirements that relate to those programs. 34 CFR § 99.35. For purposes of this Evaluation, which is an evaluation of a federal or state supported education program, the College designates Mathematica as its authorized representative, and the College may disclose PII from education records to Mathematica without prior student consent for the limited purpose of conducting the Evaluation.

Article 2. TERM OF THE MOU

This MOU is effective as of the date of the last signing party below and shall terminate on the later date of termination of the Evaluation Contracts, currently anticipated to terminate on December 31, 2017.

Article 3. COVERED DATA AND TIMEFRAME FOR COLLECTION

a. Covered Data. For purposes of Mathematica’s performance of the Evaluation, the College will provide Mathematica with the data variables listed in Exhibit A, attached hereto and incorporated herein by reference (the “Covered Data”). The parties may, in good faith, mutually agree to amend the specific data variables listed in Exhibit A without modifying this MOU.

b. Anonymous Student Identifier. Before providing the Covered Data to Mathematica, the College may remove PII, such as name and Social Security number, from student records compiled by the College or an external agency, such as a state or regional workforce or human services agency, and instead provide a unique, anonymized identifier for each student that can be used by Mathematica to link student records across data sources and years.

c. Delivery of the Covered Data. The College will provide Mathematica the Covered Data according to the following schedule, subject to modifications that may be mutually agreed to by both Mathematica and the College:

February-March 2016: fall 2015 termAugust-September 2016: spring 2016 term, winter 2016 term (as applicable), fall 2015 term

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February-March 2017: fall 2016 term, summer 2016 term (as applicable), spring 2016 term, winter 2016 term (as applicable), fall 2015 term August-September 2017: spring 2017 term, winter 2017 term (as applicable), fall 2016 term, summer 2016 term (as applicable), spring 2016 term, winter 2016 term (as applicable), fall 2015 term

At each point in time, colleges should submit data on all WSSN participants, which includes participants from prior terms, whether or not they continue to receive services.

Article 4. USE OF COVERED DATA; DATA DESTRUCTION

Mathematica shall maintain the Covered Data in strict confidence and shall only use, access or disclose the Covered Data for purposes of the Evaluation, or as may otherwise be required by law.

Mathematica will access and analyze the Covered Data to perform the summative evaluation to generate evidence on program participant outcomes by service receipt and student and college characteristics. Data will only be reported in aggregate and will be stripped of all personally identifiable information in Evaluation findings and reports.

On termination of this MOU or when the Covered Data are no longer needed for purposes of the Evaluation, whichever is sooner, Mathematica will destroy all Covered Data received hereunder, and will certify to the College in writing to such destruction.

Article 5. CONFIDENTIALITY ASSURANCE

Mathematica shall protect the confidentiality of the Covered Data provided under this MOU in compliance with all applicable state and federal statutes, rules, and regulations governing the disclosure of confidential information contained in the Covered Data, including FERPA, 20 U.S.C. § 1232g, and FERPA’s implementing regulations, 34 CFR Part 99. Mathematica agrees to require and maintain an appropriate confidentiality agreement with each employee, contractor or agent that will access the Covered Data, and access to the Covered Data will be on a “need-to-know” basis only. Mathematica further agrees not to disclose or release in any manner information contained within the Covered Data that may reveal the identity of an individual, except as may be required by law.

Upon learning of any unauthorized use or disclosure of Covered Data received pursuant to this MOU, Mathematica agrees to notify the College of the unauthorized use or disclosure, make all reasonable efforts to mitigate

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any such unauthorized use or disclosure, and prevent future unauthorized uses or disclosures.

Article 6. COVERED DATA TRANSFER

Mathematica will create and host a secure, password-protected file transfer (“FX”) site that will be used by colleges to transmit data and associated documentation to Mathematica. The FX site will be organized and protected such that each college will have access only to its own site’s FX folder structure. Colleges will receive FX site training materials and will be instructed on what to include with each transmission (e.g., data file descriptions, data layouts, and other supporting documentation). For each data transmission, Mathematica staff will track key information in a tracking log. After the data has been successfully received and logged by the Mathematica Evaluation data management team, the files will be moved to their secure data processing and analysis location. Files on the FX site will be subsequently deleted after the transfer. If it is not always possible for College to use the FX site (e.g. due to file size limitations), then Mathematica will coordinate with College to arrive at alternate data transfer approaches such as shipping encrypted files and/or other secure file transfer methods.

Article 7. IRB REVIEW

a. Mathematica has received IRB approval from Health Media Labs for the Evaluation’s research protocol.

b. Mathematica will seek IRB approval by the College’s own IRB, as applicable.

Article 8. POINTS OF CONTACT

Each Party hereby designates in writing one or more individuals within its organization as its point of contact responsible for managing performance of the Party’s necessary functions and responsibilities under this MOU.

(a)For Mathematica:

Issues relating to this MOU: Issues relating to data collection:

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Pamela L. Tapscott Megan Davis ChristiansonVice President and Director of Contracts Task Lead1100 1st Street, NE, 12th Floor 1100 1st Street, NE, 12th FloorWashington, DC 20002-4221 Washington, DC 20002-4221Phone: (202) 484-3294 Phone: (202) 250-3562Fax: (202) 863-1763 Fax: (202) 863-1763 Email: [email protected] Email:

[email protected]

(b)Los Angeles Harbor College

Issues relating to this MOU: Issues relating to data collection:

[Name] [Name][Title] [Title][Address 1] [Address 1][Address 2] [Address 2]Phone: Phone:Fax: Fax:Email: Email:

All notices required or permitted to be given hereunder shall be in writing and shall be deemed given when delivered by hand, sent by courier or other express mail service, postage prepaid, or transmitted by facsimile or email, read receipt requested, addressed to a party at the address identified in this MOU.

Article 9. INDEMNIFICATION

Mathematica agrees to indemnify and hold harmless the College, its officials and employees, agents, and subcontractors from, and defend the College against, any liability or expenses (including reasonable attorneys' fees and costs) arising out of or relating to any breach of this MOU by Mathematica.

Article 10. MISCELLANEOUS

a. Modification. This MOU may be modified at any time by mutual consent of the Parties. All modifications shall be in writing and signed by both Parties. Notwithstanding the foregoing, the Parties may, pursuant to Article 3(a) herein, mutually agree to modify the Covered Data listed in Exhibit A without modifying this MOU.

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b. Counterparts. This Agreement may be signed in one or more counterparts, each of which will be deemed an original, but all of which will be deemed one instrument.

c. Enforceability. If any provision of this MOU is determined by any court of competent jurisdiction to be invalid or unenforceable, such provision shall be interpreted to the maximum extent to which it is valid and enforceable, all as determined by such court in such action, and the remaining provisions of the MOU will continue in full force and effect, without being impaired or invalidated in any way.

d. Assignment. Neither this MOU, nor any rights, duties, nor obligations described herein shall be assigned by Mathematica without the prior express written consent of the College.

e. Entire Agreement. This MOU, and the exhibits incorporated herein by reference, constitutes the Parties’ entire agreement with respect to the subject matter hereof and supersedes any and all prior statements or agreements, both written and oral.

IN WITNESS WHEREOF, the Parties hereto have caused this Memorandum of Understanding to be executed by their duly authorized representatives as of the date of the last signing party below.

Mathematica Policy Research, Inc.

By: __________________________________

Los Angeles Harbor College

By: __________________________________

Name: _______________________________

Title: ________________________________

Date: ________________________________

Name: _______________________________

Title: ________________________________

Date: ________________________________

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EXHIBIT A

Exhibit A describes the individual data elements that Mathematica is requesting, organized by data type. The evaluation team recognizes that some colleges may have difficulty providing certain data. We will work with each college and their state partner to determine which data can be provided. For example, if a particular data element is not available in college data systems, we can discuss if an alternative, available data element may be provided. Mathematica can also offer guidance on requesting workforce and public benefits data from regional or state agencies or directly from participants.

1. Participant identifiers

Unique participant identifiers allow us to link participant data across file types and track program services and outcomes over time. Thus, the most important data items we are requesting are these identifiers in all of the data files. Table 1 presents different types of participant identifiers that will work for the evaluation.

We prefer that each college assign a consistent, unique identifier to each participant over the course of the evaluation data collection. However, if it is necessary to provide different participant identifiers across file types or time periods, a college can include a “crosswalk file” with each submission, listing each identifier assigned to a given individual included in the data set. Mathematica can use this crosswalk file to link data on participants across files employing different types of identifiers.

Table 1. Participant identifiers used to link data

Data element DescriptionCollege participant identifier

Participant’s consistent, unique identifier (such as a Statewide Participant Identifier, SSID, or anonymized research ID) assigned by the college.

Social Security number Participant’s SSN; SSN may be required to link UI and public benefits data to other participant data.

Date of birth Participant’s month, day, and year of birth (for example, MM/DD/YYYY); must be provided with name and address when used for linking data because participants can share the same date of birth.

Last name Participant’s full name; must be provided with date of birth and address when used for linking data because participants can share the same full name.First name

Middle name

Street address Participant’s street address, city, state, and zip at time of data submission; must be provided with date of birth and name when used for linking data because participants can share the same address.

CityStateZip codeSSID = Statewide Student Identifier; SSN = Social Security number; UI = unemployment insurance.

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2. Participant demographic and background data

The participant demographic and background data listed in Table 2 will enable us to describe program outcomes separately for different subgroups. Demographic data include those that vary with time (time-variant data), such as marital status, or data that do not vary with time (time-invariant data), such as date of birth. Time-variant data will be used to measure participant characteristics both before and after receiving a WSSN service, whereas time-invariant data, by definition, will be measured at a single point in time.

Table 2. Participant demographic and background data

Data element Description

Participant identifiers for linking data sets

Please include items from Table 1 to enable linking these data to activity and outcome data.

Date of birth Participant’s month, day, and year of birth (for example, MM/DD/YYYY). Please do not provide participant’s age because the date of birth may be calculated at different points during the study.

Gender Participant’s gender.

Race Participant’s race. Please include all individual race categories indicated.

Ethnicity Participant’s Hispanic or Latino status.

Date of high school graduation or receipt of GED

Date participant completed high school or received a GED credential.

High school GPA High school GPA on a scale of 0.0 (F) to 4.0 (A).

Veteran status Participant’s veteran status; may be self-reported.

Disability status Participant’s disability status; may be self-identified.

Number of dependents

Number of dependents in participant’s household; may be self-reported.

Number of minor dependents

Number of dependents under the age of 18 in the participant’s household; may be self-reported.

Marital status Participant’s marital status (for example, single, married/domestic partnership, divorced, widowed); may be self-reported.

State of residence Participant’s state of residence.

Zip code of residence Participant’s zip code of residence.

GED = General Educational Development; GPA = grade point average

3. Participant financial status

The financial status data in Table 3 will allow the evaluators to examine outcomes by different participant subgroups, such as Pell recipients, and to measure changes over time, such as increased access to financial aid. To accurately examine outcomes, we are requesting data for the two terms prior to a participant’s first WSSN service receipt.

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Table 3. Participant financial status data

Data element Description

Participant identifiers for linking data sets

Please include items from Table 1 to enable linking these data to activity and outcome data.

FAFSA filing date Date a participant filed an FAFSA for federal financial aid.

Pell Grant receipt Indication (for example, Y or N) whether participant received federal Pell Grant assistance.

Date of Pell receipt Date Pell Grant was received or awarded.

Other economic disadvantaged status

Indication of receipt of state or other program or benefit for economically disadvantaged students, such as an enrollment fee waiver. Please indicate the name of the program or benefit and include additional data elements, such as amount and date received, as relevant.

Subsidized federal loans Indication (for example, Y or N) whether participant received subsidized federal loans.

Date subsidized loan received

Date subsidized loan was received or awarded.

Unsubsidized federal loans Indication (for example, Y or N) whether participant received unsubsidized federal loans.

Date unsubsidized loan received

Date unsubsidized loan was received or awarded.

Other loan(s) received to attend college

Indication (for example, Y or N) whether participant received this loan(s).

Date other loan(s) received Date other loan(s) was received or awarded.

Scholarship receipt Indication (for example, Y or N) whether participant received a scholarship.

Date scholarship receipt Date scholarship was received or awarded.

Tuition assistance receipt Indication (for example, Y or N) whether participant received tuition assistance from an employer.

Date tuition assistance received

Date tuition assistance was received.

Annual gross income Annual gross income (income before taxes).

Credit score Participant’s credit score.

Date credit score received Date student received credit score.

Credit agency Agency providing credit score (such as Experian, Transunion, and Equifax); indicate if self-reported or unknown.

FAFSA = Free Application for Federal Student Aid

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4. Participant program of study and coursework

The data on participants’ program of study and coursework in Table 4 will allow us to examine postsecondary programmatic and course-taking patterns before and after receiving WSSN services. To allow us to do this, please provide data on all programs of study and coursework ever taken by each participant at your college, including WSSN and non-WSSN courses, credit and noncredit courses, and remedial courses. Colleges may provide the data on coursework (Table 5) in a separate file, with each student having a separate row for courses taken each term.

Table 4. Participant program of study

Data element Description

Participant identifiers for linking data sets

Please include items from Table 1 to enable linking these data to activity and outcome data.

Campus of college The campus of the college at which student is enrolled during each term, if relevant.

Name of program of study Name of each program of study in which participant was enrolled (such as Business, Computer Science, Nursing).

Type of degree awarded Type of each degree awarded to participant, such as A.A., A.S., or B.S.

Date degree awarded Date each degree was awarded.

Name of certification awarded

Name of each certification awarded to participant, such as a certification in medical coding or supply chain management.

Date certification awarded Date each certification was awarded.

Table 5. Participant coursework

Data element Description

Participant identifiers for linking data sets

Please include items from Table 1 to enable linking these data to activity and outcome data.

Campus of college The college campus at which course was taken, if relevant.

Enrollment status Indicate whether student was enrolled either full-time or part-time during each term. Full-time status is defined as 12 or more credit hours per term. Part-time status is defined as less than 12 credit hours per term.

Course identifier Numeric or alphanumeric Identifier of each course taken by participant.

Name of course Name of each course taken by participant.

Course section Section of course taken by participant.

Course start date Date the participant started course.

Course end date Date the course ended or participant exited course (if withdrawal or other exit reason).

Credit status of course Indicate whether course was credit or noncredit (may be indicated by course identifier).

Credits possible for course

Total number of credit hours possible for completing the course.

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Data element DescriptionCourse grade Grade received by participant at completion of course.

Course credit hours completed

If credit course, credit hours received by participant upon completion of course.

Course exit reason Reason for course exit (for example, dropped, withdrawal, credit awarded, credit not awarded).

5. Participant WSSN services Service data are at the core of the evaluation and allow us to examine

relationships between services received and outcomes, such as postsecondary credentials, receipt of public benefits, and wages and employment. The data elements listed in Table 6 could be available for several modes of service delivery, some of which may not be applicable to your college or to all services you provide. We will work with each college to understand what it can provide by mode of service, including any additional data elements available on services. Ultimately, Mathematica will create a service data file that contains entries at the participant-encounter-service level. That is, the file will allow us to examine each dated service encounter, such as a meeting with a case manager, and any service outcomes resulting from each encounter, such as a referral to a job training workshop or a public benefits agency. Colleges may provide data for different modes of services in separate files, as long as a common, unique identifier is used for each participant that allows us to link the files. Table 6. WSSN service data

Data element Description

Participant identifiers for linking data sets

Please include items from Table 1 to enable linking these data to activity and outcome data.

Begin date of service encounter

The begin date of the service encounter.

End date of service encounter

The end date of the service encounter, which may be the same as the begin date.

Mode of service delivery encounter

The way in which a service was provided to the participant or how the participant participated in the service; for example, through one-on-one counseling or a workshop.

Service provider identifier Unique identifier for each service provider connected to an activity that is consistent across data files and years; these identifiers should be the same used in the service provider background data.

Campus of service (name)

The name of the campus at which the dated service encounter took place, if applicable.

WSSN pillar(s) The WSSN pillar or pillars to which the dated service encounter applies.

Service activity or content area

The activity in which a participant participated or the content covered in the service encounter. List multiple activities or content areas separately for each dated encounter, if applicable.

Start date of service activity or content

The start date of a service activity or content, if applicable, which may differ from the begin date of an associated service encounter.

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Data element DescriptionEnd date of service activity or content

The end date of a service activity or content, if applicable, which may differ from the end date of an associated service encounter.

Service activity or content outcome

An outcome of a service activity or content (for example, credit score received, resume created, or completed application for SNAP).

SNAP = Supplemental Nutrition Assistance Program; WSSN = Working Student Success Network.

6. Participant wages and employment

Participant wage and employment data allow us to examine participants’ economic stability and self-sufficiency before and after receiving WSSN services. We encourage colleges to request Unemployment Insurance (UI) records on participants from their state or regional workforce agency. If this is not possible, then we encourage colleges to collect wage and employment information directly from all participants. Mathematica will discuss with each college and their state partner what is possible and can provide guidance on requesting UI records from regional or state agencies as well as best practices for collecting self-reported data from participants. Table 7 lists both self-reported wage and employment data requested and the data elements available from UI records.

Table 7. Participant wage and employment data

Data element DescriptionParticipant identifiers for linking data sets

Please include items from Table 1 to enable linking these data to activity and outcome data.

Term/year of data The term and year of data provided.

Annual gross salary Participant’s annual salary (before taxes).

Hourly wage If annual salary not provided, wage per hour earned by participant; if more than one job during a term, provide an average hourly wage or each hourly wage by job title or employer.

Hours worked per week Indicate the number of hours worked per week; if more than one job during a term, provide an average number of hours worked per week or the number of hours worked by job title or employer.

Employment status Indicate if participant is unemployed, employed part-time (32 hours per week or less), or employed full-time (33 hours per week or more).

Employer name Name of each employer.

Employer industry Industry of each employer (for example, manufacturing, health care, food service).

Job title Title of each job held by participant.

Employment start date Start date of each job held by participant.

Employment end date End date of each job held by participant.

Quarter and year provided

Quarter and year of data provided.

Total quarterly earnings Total earnings by quarter.

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Data element DescriptionEmployer identifier Identifier of each employer per quarter.

Employer NAICS code NAICS code for each employer per quarter.

NAICS = North American Industry Classification System; WSSN = Working Student Success Network.

7. Participant public benefits data

Participant public benefits data allow us to examine public benefits receipt for program participants before and after receiving WSSN services. We are requesting that colleges collect these data from their state or regional human services agency. If this is not possible, then we encourage colleges to collect public benefits information directly from all participants. Mathematica will discuss with each college what is possible and can provide guidance on requesting public benefits records from regional or state agencies as well as best practices for collecting self-reported data from participants. Table 8 lists both self-reported public benefits data requested and the data elements commonly available from human service agencies.

Table 8. Participant public benefits dataData element Description

Participant identifiers for linking data sets

Please include items from Table 1 to enable linking these data to activity and outcome data.

Number of household members

The number of members in participant’s household for which he or her received benefits.

Number of dependents The number of dependents in the participant’s household for which he or her received benefits.

SNAP receipt Indication (for example, Y or N) whether participant received federal SNAP assistance during each term.

SNAP benefits amount The amount of SNAP benefits, if received, each month; if amount varies, then average amount received.

SNAP months received The number of months SNAP was received for the term.

TANF receipt Indication (for example, Y or N) whether participant received federal TANF assistance during each term.

TANF benefits amount The amount of TANF benefits, if received, each month; if amount varies, then average amount received.

TANF months received The number of months TANF was received for the term.

Medicaid/CHIP receipt Indication (for example, Y or N) whether participant received federal Medicaid/CHIP assistance during each term.

Medicaid/CHIP months received

The number of months Medicaid/CHIP was received for the term.

Childcare assistance receipt

Indication (for example, Y or N) whether participant received childcare assistance during each term, such as Head Start or Early Head Start.

Childcare assistance amount

The amount of childcare assistance, if received, each month; if amount varies, then average amount received.

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Data element DescriptionChildcare assistance months received

The number of months childcare assistance was received for the term.

[NAME of other assistance] receipt

Indication (for example, Y or N) whether participant received [NAME of other assistance] during each term.

[NAME of other assistance] amount (as applicable)

The amount of [NAME of other assistance], if received, each month, as applicable; if amount varies, then average amount received.

[NAME of other assistance] months received

The number of months [NAME of other assistance] was received.

SNAP benefits amount The amount of SNAP benefits, if received, for each month.

SNAP date received The date each SNAP amount was received.

SNAP number of household members

The total number of members in participant’s household for SNAP.

SNAP number of dependents

The total number of dependents in the participant’s household for SNAP.

SNAP head of household Indication (for example, Y or N) if participant is the head of household for SNAP.

SNAP dependent Indication (for example, Y or N) if participant is a dependent in household for SNAP.

TANF benefits amount The amount of TANF benefits, if received, for each month.

TANF date received The date each TANF amount was received.

TANF number of household members

The total number of members in participant’s household for TANF.

TANF number of dependents

The total number of dependents in the participant’s household for TANF.

TANF head of household Indication (for example, Y or N) if participant is the head of household for TANF.

TANF dependent Indication (for example, Y or N) if participant is a dependent for TANF.

Childcare assistance amount

The amount of childcare assistance, if received, for each month.

Childcare assistance date received

The date each childcare assistance amount was received.

Number of household members

The number of members in participant’s household for childcare assistance.

Number of dependents The number of dependents in the participant’s household for childcare assistance.

Childcare assistance head of household

Indication (for example, Y or N) if participant is the head of household for childcare assistance.

Medicaid/CHIP receipt Indication whether participant received Medicaid/CHIP benefits.

Medicaid/CHIP date received

The date Medicaid/CHIP benefits were received.

Medicaid/CHIP number of household members

The total number of members in participant’s household for Medicaid/CHIP.

Medicaid/CHIP number of dependents

The total number of dependents in the participant’s household for Medicaid/CHIP.

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Data element DescriptionMedicaid/CHIP head of household

Indication (for example, Y or N) if participant is the head of household for Medicaid/CHIP.

Medicaid/CHIP dependent Indication (for example, Y or N) if participant is a dependent for Medicaid/CHIP.

[NAME of other assistance] amount (if applicable)

The amount of [NAME of other assistance], if received, each month (if applicable).

[NAME of other assistance] date received

The date each [NAME of other assistance] amount was received.

[NAME of other assistance] number of household members

The total number of members in participant’s household for [NAME of other assistance], if applicable.

[NAME of other assistance] number of dependents

The total number of dependents in the participant’s household for [NAME of other assistance], if applicable.

[NAME of other assistance] head of household

Indication (for example, Y or N) if participant is the head of household for [NAME of other assistance], if applicable.

[NAME of other assistance] dependent

Indication (for example, Y or N) if participant is a dependent for [NAME of other assistance], if applicable.

CHIP = Children’s Health Insurance Program; SNAP = Supplemental Nutrition Assistance Program; TANF = Temporary Assistance for Needy Families; WSSN = Working Student Success Network.

8. Service provider background

Service provider background information will allow us to examine the different types of service providers under the WSSN initiative. Mathematica will work with colleges to determine which data are available on providers by mode of service. The data listed in Table 9 need to be provided only once for all service providers, including any instructors, who delivered any WSSN services from fall 2015 through spring 2017. The identifiers provided in the service provider background data must be the same identifiers submitted for those providers in participant service data files and course record information (if services are provided through a course, for example).

Table 9. Service provider background data

Data element Description

Service provider identifier A unique identifier assigned by the program, college, or state that is consistent across data files and years.

Service provider title Title of service provider, if applicable.

Service provider department

Department of service provider (for example, Humanities department, Financial Aid, Participant Affairs, Counseling Center). Include either main department or multiple entries, if applicable.

Organization of service provider

Name of organization of service provider, if applicable. Include names of organizations external to the college as well as any college organizations offering services.

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