Parent Consent Form for student participation

Parent Consent Form For Student Participation

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.

Your signature is required for your child to participate in the research study. 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. Some parents of children participating in the study will also be asked to complete surveys asking about their children’s behavior. The information we collect will help us to better understand how the program is working. Presented below is information about the student survey.

Survey Content. The survey will gather information about your child’s perception of the school as a caring community, her/his endorsement of values consistent with good character, and her/his behavior. It will take about 35 minutes of classroom time to complete.

Student Selection. All students in your child’s classroom are being asked to participate in the research study.

It is Voluntary. Your child does 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. Students only have to answer the questions they want to answer and they may stop taking it at any time. Before the survey begins, the survey’s purpose, content, and procedures will be explained again. Your child will be able to ask questions and decline to participate.

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. Data from surveys and student records will be made available to WestEd only under strict confidentiality controls. 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 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.

By my signature, I agree to allow the following child(ren) to participate in this study. I

acknowledge that the child(ren)'s answers are private.

_____________________________________

(CHILD'S NAME)

_____________________________________

(CHILD'S NAME)

_____________________________________ _______________

(SIGNATURE OF PARENT/GUARDIAN) (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.