Phase 2 Parental Information and opt out form

Parental Information and Opt-Out Form
[School Letterhead]
August XX, 2014
Dear Parent or Guardian:
[Insert high school] is committed to helping our students graduate college and career ready. As
part of our commitment, we are working with the Regional Educational Laboratory (REL)
Midwest to study a schoolwide guidance program called Ramp-Up to Readiness (“Ramp-Up”).
Scholars at the College Readiness Consortium at the University of Minnesota developed RampUp based on existing research.
The purpose of this letter is to let you know that we plan to release some information about the
students in [high school] to REL Midwest and that your son or daughter may be asked to
complete a survey and college-readiness assessment. The information provided to REL Midwest
will not include student names or any other personally identifiable information about you or your
child. In other words, the data will be anonymous to the researchers.
Parents and students should understand the following:
This anonymous information will help the research team better understand the challenges that
schools have in carrying out Ramp-Up and the experiences students have when participating in
Ramp-Up activities.
The anonymous information will include students’ grades, test scores, course enrollments,
college enrollment activities, and the student identification number used by the Minnesota
Department of Education. The researchers will be able to use your son’s or daughter’s
identification number to obtain other information from state databases, such as test scores, but
they will be unable to link that number with your child’s identity.
As part of the study, your son or daughter may be asked to do the following:


Take surveys during the fall and spring that asks about his or her experiences at school
with planning and preparing for life after high school.



Take an online college-readiness assessment (ACT’s ENGAGE assessment) in the fall
and spring. This assessment will measure students’ motivation and skills, social
engagement, or self-regulation.



No student has to answer questions on the surveys or assessments that he or she does not
want to answer.



All information about your child will be anonymous. The information collected will only
be used for this research project, and the researchers will average the data for all students
and all participating schools. They will report these averages in government reports and
research articles, but readers will be unable link those findings with individual students,
teachers, or schools.
OMB Control Number XXXX-XXXX (Exp XX/XX)

Parental Information and Opt-Out Form
[School Letterhead]


Risks: This study presents minimal risk to your child. That is, students do not experience
any risks beyond what they experience every day at school.



Benefits: Study participation helps build knowledge about how to better support students
to be college or career ready.



Participation in the study is voluntary. Students do not have to participate if they do not
want to, and they will experience no repercussions at school if they decide not to
participate. Our school’s participation in this research study helps educators learn more
about how schools can help students become college and career ready.

If you do not wish us to release anonymous information for your child or have your child
complete the surveys and assessments, please fill in the form below and have your son or
daughter return this letter to [return location] by [deadline].
If you have questions about this research project or about your child’s rights as a participant,
please contact Jim Lindsay of REL Midwest at 630-649-6591.
Sincerely,
[insert district signatory]

By signing this form, you are indicating that you do not wish your child to participate in the
study or for us to share your child’s information with the REL Midwest research team.
I do NOT want my child, __________________________________________,
Full Student Name
(Student ID # _____________________) to participate in the Ramp-Up evaluation being
conducted by REL Midwest.
Your name: ______________________________________________________
Your signature: ___________________________________________________

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB
control number. The valid OMB control number for this information collection is 1850-XXXX, OMB expiration date is XXXX, XX, 2017. The time
required to complete this information collection is estimated to average 5 minutes per respondent, including the time to review instructions, gather the
data needed, and complete and review the information collected. 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, DC 20202. If you have comments or concerns
regarding the status of your individual submission of this form, write directly to: U.S. Department of Education, Institute of Education Sciences, 555
New Jersey Avenue, NW, Washington, DC 20208.

OMB Control Number XXXX-XXXX (Exp XX/XX)