Student Assent Form

S
tudent Assent to Participate in High School Math Assessment

Study of Secondary Math Teachers

School Name: [PRE-FILL]

Teacher Name: [PRE-FILL]

Math Class: [PRE-FILL]

Student Name [PRE-FILL]

Your school district, your school and your parent/guardian have given Mathematica Policy Research, Inc. permission to conduct this study about how well different math teachers do their jobs. As part of the study, you will be given a 45 minute test of math skills.

This test will have no effect on your grades but it will provide useful information for the study.

Participation in the study is voluntary, and you can stop participating in the test at any time. If you choose not to take part in the study, it will not affect your grades or, the instruction or other services you receive at school. Your parent/guardian(s) know that you are participating in this study.

Before you begin, please read the statements below and check the appropriate box.

The test was explained to me and I want to participate.

The test was explained to me and I do not want to participate.

Thank You

Per the policies and procedures required by the Education Sciences Reform Act of 2002, Title I, Part E, Section 183, responses to this data collection will be used only for statistical purposes. The reports prepared for this study will summarize findings across the sample and will not associate responses with a specific district or individual. We will not provide information that identifies you or your district to anyone outside the study team, except as required by law. Any willful disclosure of such information for nonstatistical purposes, without the informed consent of the respondent, is a class E felony.