Attachment F Parent consent form

ATTACHMENT F

PARENT CONSENT FORM

THE Examining data informing teaching (EDIT) development PROJECT

consent form FOR PARENTS

What is the purpose of the research study?	The purpose of the study is to develop a new research tool to help us learn how teachers assess children in their classrooms and use the information to tailor classroom instruction. The project is sponsored by the Administration for Children and Families in the U.S. Department of Health and Human Services.
Who is being invited to participate in the research study?	The pretest of the measure will involve teachers and children in 9 early childhood classrooms. Participation is voluntary; refusal to participate in the study will not negatively affect your relationship with your program or your child’s teacher. Even if you agree to participate in the study, you may withdraw at any time.
When will the research study be conducted?	The study activities in which we are inviting teachers and children to participate will take place from October 2015 to May 2016.
What information will be collected?	If you agree to participate, the study may collect information about your child in two ways: (1) video-recordings of your child’s teacher administering assessments and instruction to your child and (2) reviewing assessment and instruction information that the teacher has collected about your child. All the information we collect will be used for research and educational purposes only.
Who is conducting the research study?	Mathematica Policy Research is conducting the study for the Administration for Children and Families. Mathematica is a nationally recognized, nonpartisan research organization that conducts studies in early childhood education and other public policy areas. Additional information about Mathematica can be found online at http://www.mathematica-mpr.com.

How will Mathematica protect the privacy of research study participants?		Mathematica is committed to respecting the privacy of everyone who contributes to this study. Should you give permission for your child to take part in the study, all information about your child will remain private to the extent permitted by law. Your child’s name will never be associated with or identified in study reports.
How can I get more information about the research study?		If you have any questions or would like more information about the study, please contact Shannon Monahan at Mathematica at 609-275-2207, or via email at smonahan@mathematica-mpr.com.
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 control number. The OMB control number for this collection is 0970-0355 and it expires 03/31/2018. Please read the following statements, check the appropriate box, and complete the bottom section.  Yes, I give my permission to have my child take part in the study. I agree that my child’s teacher may submit assessment and instruction information about my child, and talk with researchers about how she/he uses assessment data to tailor instruction for my child. I also agree that my child’s teacher may video-record my child. I understand this information will be shared with the study team and may be used for research and educational purposes and give permission for its use. I will receive no proceeds or compensation for the use of the video-recording for these research or educational purposes or for the tool’s future revisions, editions, translations, adaptations, and other formats. The videos will be stored by Mathematica until the project ends and they are no longer required, at which time they will be destroyed. I may withdraw this consent at any time. I have read this form and have received a copy for my records.  No, I do not give my permission to have my child take part in the study. I have read this form and have received a copy for my records. Your Child’s Name Your Printed Name Your Signature Date