Parent Consent Form

Parent Consent Form For Parent Report

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. Over the course of the study (2007-2009), the study data collection activities (e.g., questionnaires, interviews etc.) will take approximately 1 hour to complete. 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 complete surveys about their children’s behavior. The information we collect will help us to better understand how the program is working. Upon completing the survey each year, a $10 gift certificate will be provided to you as our way of showing our appreciation for your time and efforts.

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 12 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)

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number.  The valid OMB control number for this information collection is 1850-0826.  The time required to complete this information collection is estimated to average 15 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.  If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to:  U.S. Department of Education, Washington, D.C. 20202-4700.  If you have comments or concerns regarding the status of your individual submission of this form, write directly to:  Ok-Choon Park, U.S. Department of Education, 555 New Jersey Avenue, N.W., Room 506E, Washington, D.C. 20208.