Parent Consent Form

Parent Consent Form

Parental Consent for Lessons in Character Program Evaluation

Dear Parent,

Your child’s school is interested in receiving training and materials to implement the Lessons in Character program in the 2007/08 and 2008/09 school year. The Lessons in Character program is designed to improve children’s literacy skills and promote the ethical, social, and personal integrity of students. You and your child are being asked to participate in a research project designed to evaluate the effects of the Lessons in Character Program on academic performance, school behavior and motivation, and endorsement of values consistent with good character. The research is conducted by WestEd with funding from the U.S. Department of Education. It is directed by Dr. Thomas Hanson and Dr. Barbara Dietsch.

To find out how well the program is working, we will administer a short survey to each participating student in fall 2007, spring 2008, and spring 2009 and examine student records. We will also ask teachers to complete surveys asking about students in their classroom. You and some other parents have been randomly selected to be asked to complete surveys about their children’s behavior. The information we collect will help us to better understand how the program is working.

Survey Content. The survey will gather information about your child’s behavior and her/his family background. It will take about 20 minutes to complete.

Parent Selection. A random sample of 10 parents of students in your child’s classroom are being asked to fill out this survey.

It is Voluntary. You do not have to participate in the study or take the survey. There will be no actions or penalties against you or your child for not participating. You only have to answer the questions that you want to answer, and you may stop taking it at any time.

It is Confidential. No names will be recorded or attached to the survey forms or data, but an identification code will be assigned to each survey form. This is necessary to track changes in student observations during the next three years. Data from this survey will be sent to the evaluator, WestEd, for processing and analysis. Access to identifying information will be limited to select personnel and will be password protected. All data will be reported only in aggregate form to prevent inadvertent disclosure of information.

Potential Risks. There are no known risks to you or your child for participating in the study.

Where to Turn for Further Information. If you have any questions or concerns about the research, please feel free to contact Barbara Dietsch, Project Director, WestEd, 4665 Lampson Avenue, Los Alamitos, CA 90720, (562) 799-5126. You may examine a copy of the survey in the school office.

I understand the procedures describe above. My questions have been answered to my satisfaction, and I agree to participate in this study. I acknowledge that my answers are private. I have been given a copy of this form.

_____________________________________ _______________

(SIGNATURE OF PARTICIPANT) (DATE)

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