Non-Disclosure Form

IEPR: Non-Disclosure Agreement

PROGRAM

GOVERNMENT AGENCY REPRESENTED ASN RD&A

UNDERSIGNED ORGANIZATION

ADDRESS

PHONE #

The accuracy and usefulness of the assessment results is critically dependent upon everyone’s ability to speak freely and without fear of retribution. One key factor of this open communication is assessment confidentiality--specifically:

1. All information gathered through or derived from program profile questionnaire responses, project manager discussions, and practitioner group discussion or individual interviews will be treated by the assessment team as confidential and will not be reported to anyone outside the assessment team with attribution to individuals or projects. All materials, including notes taken during the assessment, will be turned over to the Team Leader at the completion of the assessment.

2. All assessment participants (assessment team members, project managers, and practitioners) agree not to discuss information they share or learn from assessment confidential meetings with anyone other than the assessment team.

3. All assessment results will be documented and presented without attribution to individuals or specific projects.

4. All assessment results are proprietary to the organization and may not be distributed or discussed in any forum outside the evaluated organization without the approval of the sponsor.

I, THE UNDERSIGNED, AGREE TO THE PROVISIONS LISTED ABOVE.

______SIGNATURE DATE

Revised 20-Nov-01