Mailing Address Form

OMB #: 0970-0355

Expiration Date: 01/31/2015

Family and Provider/Teacher Relationship Quality Study

Thank you for participating in the Family and Provider/Teacher Relationship Quality (FPTRQ) study! Remember, your participation is completely voluntary, and your responses will remain private. The enclosed survey should take about 10-15 minutes to complete. As a token of our appreciation, we will send you a check for $20 upon receipt of your completed survey.

Please write the name and address of the person to whom the check should be sent:

Name: _____________________________________________

Mailing address: _____________________________________

_____________________________________

_____________________________________

Please return this form in the enclosed pre-paid mailing envelope along with your completed survey. We will send a check to this address within one week after we receive your completed survey.

An agency may not conduct or sponsor and a person is not required to respond to, a collection of information unless it displays a currently valid OMB number.