Appendix I -Parent Consent Form

Appendix I: Parental Consent Form

National Study of Multi-Tiered Systems of Support for Behavior (MTSS-B)

Dear Parent or Guardian:

Your child’s school is part of a national study for the U.S. Department of Education. The goal of the study is to understand how a program to support good student behavior in schools works. The program is called Multi-Tiered Systems of Support for Behavior or MTSS-B. Schools in the study were chosen by a lottery to receive training in the new program or keep using their existing program. This form asks you to give permission for the study team to collect information on your child.

The study is being led by a research group called MDRC. MDRC has three partners helping it collect data for this study—American Institutes of Research (AIR), Decisions Information Resources (DIR) and Harvard Graduate School of Education. These four groups are the study team that will be working with your child’s school.

[Number] elementary schools in your school district agreed to be in the study. Your child’s school is one of them. As part of the study, between the fall of 2015 and spring of 2017:

• Teachers will fill out surveys about students’ behavior up to three times.

• Students may be asked to participate in a 1-2 minute interview about their school.

• Students in grades 4 and 5 will be asked to complete a survey about their behavior as well as their thoughts, feelings and experiences at school. The survey will take place in the classroom and take 20-25 minutes to complete.

• The study team will also get information from your School or School District about how your student is doing in school and their behavior in school. The team will also get some additional student information such as: what is the student's race and ethnicity and does the student receive free or reduced price lunches.

It is important for you to understand the following information:

• Information collected for this study comes under the confidentiality and data protection requirements of the Institute of Education Sciences. All information from this study will be kept confidential as 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. Personally identifiable information about individual respondents will not be reported. We will not provide information that identifies you, your child, your child’s school, or your district to anyone outside the study team, except as required by law.

• The study presents minimal risk to your child and has been approved by a group that looks at the risks of studies called the Institutional Review Board.

• If you let your child be part of data collection this helps educators learn about how to improve student behavior in schools.

• Being part of the data collection for this study is voluntary. You may pull your child out of the student survey and teacher survey about student behavior at any time. Doing this will not affect your child’s rights in any way.

• You have the right to review a survey and/or instructional materials before the survey is given to your student. If you would like to review the survey please contact the project’s Director, Fred Doolittle, at fred.doolittle@mdrc.org or by calling 212-340-8638.

There is a permission form with this letter for you to fill out. If you say you agree, this form will allow your child to part of the student survey and teacher survey about student behavior.

If you want more information about this study, please contact the project’s Director, Fred Doolittle, at fred.doolittle@mdrc.org or by calling 212-340-8638. If you have questions about your child’s rights as part of the study, you should contact Amy Nowell, Institutional Review Board, MDRC 212-532-3200.

Parent Permission Form

Multi-Tiered Systems of Support for Behavior (MTSS-B)

CHILD’S FULL NAME (PLEASE PRINT)

CHILD’S GRADE ______________________________________________________________

CHILD’S DATE OF BIRTH __________________________________________

CHILD’S CLASSROOM TEACHER

CHILD’S SCHOOL _________________________________________

MARK ONE:

• I give permission for my child’s teacher(s) to complete a survey about his/her behavior and for my child to participate in a survey (grades 4 &5 only). I understand that this permission is being granted for the 2015-2016 and 2016-2017 school-years.

I agree to the rules on the earlier page and I understand that I may pull my child from the data collection at any time if I change my mind. Also, I understand my child may choose not to answer any questions that he/she does not want to answer. Your signature shows that you have read and understand the information about the study and have had a way to ask questions.

• I DO NOT give permission for my child to participate in the student survey or for my child’s teachers to complete a survey about his/her behavior.

SIGN AND DATE:

SIGNATURE OF PARENT OR GUARDIAN

DATE

YOUR FULL NAME (PLEASE PRINT)