Class Schedule and Roster Request Letter

APPENDIX D
LETTER REQUESTING CLASS SCHEDULES AND STUDENT ROSTERS

OMB Number: [XXXXXX]
Expiration Date: [XXXXX]

Request for active consent
(student assent not required)

1100 1st Street, NE, 12th Floor
Washington, DC 20002-4221
Phone: (202) 484-9220
Fax: (202) 863-1763
www.mathematica-mpr.com

districts

[Month, 2019]
Dear [TEACHER FIRST NAME] [TEACHER LAST NAME]:
Thank you for taking part in the Impact Evaluation of Departmentalized Instruction in Elementary Schools,
sponsored by the United States Department of Education and conducted by Mathematica Policy Research. As you
may know, [School District] is participating in this study and your school is one of [XX] schools selected to
participate during the 2018-2019 school year. The study will examine differences between elementary schools that
organize classroom instruction into self-contained classrooms (where one teacher instructs all core subjects) and
those that are departmentalized (where different teachers teach math and English/language arts). The study will
focus on fourth and fifth grade math and English/language arts classes.
As a fourth grade teacher, you will be asked to participate in a few data collection activities during the school year,
including video recorded classroom observations of one or more of your classes in spring 2019.
In preparation for the video observations, we will first obtain parent permission for students to be included in the
recording. A member of our local data collection team will visit your school in a few weeks to:
Obtain your daily/weekly schedule of classes. We can work from an original or copy of an accurate schedule of
classes you teach. If your schedule changes during the week, we will work with your weekly schedule.
Obtain student rosters. Working from your daily schedule of classes, we will identify classes that will be recorded.
For each of those classes, we will ask for a student roster or any full list of students (first and last names and grade)
enrolled in each class. The accuracy of this list will be very important as we will use it to track parent permission
forms indicating whether students are allowed to be recorded.
Distribute parent permission forms. During a second visit to the school, after we have finalized the list of classes
that will be recorded and the students in those classes, we will work with you to distribute parent permission packets
to students and ask them to take the packets home for their parents to review and then to return the packets to you
within a week. We will check the following week to collect returned forms and to distribute a second packet to
students who have not returned the forms. Teachers will receive $25 for helping us distribute these forms. Teachers
who collect signed forms from 85 percent or more of their students (whether or not parents gave permission to have
their child included in recordings) will receive an additional $25 as a thank you for their efforts.
All information you provide will be kept strictly confidential (per the policies and procedures required by the
Education Sciences Reform Act of 2002, Title I, Part E, Section 183) and will not be shared with anyone outside the
study team. All forms, student lists, and video recordings will be destroyed at the end of the study.
Mathematica staff will be happy to answer any questions about the study or the information it collects. You can
contact us toll-free at [TOLL FREE NUMBER] or email us at [STUDY EMAIL]. If you have questions about your
rights as a study participant, please call the New England Institutional Review Board toll-free at 1-800-232-9570.
Thank you in advance for your help with this important study!
Sincerely,
Sheila Heaviside, Survey Director
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid
OMB control number. The valid OMB control number for this information collection is xxxx-xxxx. The time required to complete this information collection is
estimated to average one hour, including the time to review instructions and gather the data needed. If you have any comments concerning the accuracy of
the time estimate 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 content or the status of your individual submission of this form, write directly to: U.S. Department of Education, Institute of Education
Sciences, 550 12th Street, SW, Washington, DC 20202.

An Affirmative Action/Equal Opportunity Employer

OMB Number: [XXXXXX]
Expiration Date: [XXXXX]

Request for active consent
(student assent required)

1100 1st Street, NE, 12th Floor
Washington, DC 20002-4221
Phone: (202) 484-9220
Fax: (202) 863-1763
www.mathematica-mpr.com

districts

[Month, 2019]
Dear [TEACHER FIRST NAME] [TEACHER LAST NAME]:
Thank you for taking part in the Impact Evaluation of Departmentalized Instruction in Elementary Schools,
sponsored by the United States Department of Education and conducted by Mathematica Policy Research. As you
may know, [School District] is participating in this study and your school is one of [XX] schools selected to
participate during the 2018-2019 school year. The study will examine differences between elementary schools that
organize classroom instruction into self-contained classrooms (where one teacher instructs all core subjects) and
those that are departmentalized (where different teachers teach math and English/language arts). The study will
focus on fourth and fifth grade math and English/language arts classes.
As a fourth grade teacher, you will be asked to participate in a few data collection activities during the school year,
including video recorded classroom observations of one or more of your classes in spring 2019.
In preparation for the video observations, we will first obtain parent permission for students to be included in the
recording. A member of our local data collection team will visit your school in a few weeks to:
Obtain your daily/weekly schedule of classes. We can work from an original or copy of an accurate schedule of
classes you teach. If your schedule changes during the week, we will work with your weekly schedule.
Obtain student rosters. Working from your daily schedule of classes, we will identify classes that will be recorded.
For each of those classes, we will ask for a student roster or any full list of students (first and last names and grade)
enrolled in each class. The accuracy of this list will be very important as we will use it to track parent permission
and student assent forms indicating whether students are allowed to be recorded.
Distribute parent permission and student assent forms. During a second visit to the school, after we have
finalized the list of classes that will be recorded and the students in those classes, we will work with you to distribute
packets to students and ask them to take the packets home for them and their parents to review and then to return the
packets to you within a week. We will check the following week to collect returned forms and to distribute a second
packet to students who have not returned the forms. Teachers will receive $25 for helping us distribute these forms.
Teachers who collect signed forms from 85 percent or more of their students (whether or not students gave assent or
parents gave permission to have their child included in recordings) will receive an additional $25 as a thank you for
their efforts.
All information you provide will be kept strictly confidential (per the policies and procedures required by the
Education Sciences Reform Act of 2002, Title I, Part E, Section 183) and will not be shared with anyone outside the
study team. All forms, student lists, and video recordings will be destroyed at the end of the study.
Mathematica staff will be happy to answer any questions about the study or the information it collects. You can
contact us toll-free at [TOLL FREE NUMBER] or email us at [STUDY EMAIL]. If you have questions about your
rights as a study participant, please call the New England Institutional Review Board toll-free at 1-800-232-9570.
Thank you in advance for your help with this important study!
Sincerely,
Sheila Heaviside, Survey Director
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid
OMB control number. The valid OMB control number for this information collection is xxxx-xxxx. The time required to complete this information collection is
estimated to average one hour, including the time to review instructions and gather the data needed. If you have any comments concerning the accuracy of
the time estimate 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 content or the status of your individual submission of this form, write directly to: U.S. Department of Education, Institute of Education
Sciences, 550 12th Street, SW, Washington, DC 20202.

An Affirmative Action/Equal Opportunity Employer

OMB Number: [XXXXXX]
Expiration Date: [XXXXX]

1100 1st Street, NE, 12th Floor
Washington, DC 20002-4221
Phone: (202) 484-9220
Fax: (202) 863-1763
www.mathematica-mpr.com

Request for passive consent districts
(student assent not required)

[Month, 2019]
Dear [TEACHER FIRST NAME] [TEACHER LAST NAME]:
Thank you for taking part in the Impact Evaluation of Departmentalized Instruction in Elementary Schools,
sponsored by the United States Department of Education and conducted by Mathematica Policy Research. As you
may know, [School District] is participating in this study and your school is one of [XX] schools selected to
participate during the 2018-2019 school year. The study will examine differences between elementary schools that
organize classroom instruction into self-contained classrooms (where one teacher instructs all core subjects) and
those that are departmentalized (where different teachers teach math and English/language arts). The study will
focus on fourth and fifth grade math and English/language arts classes.
As a fourth grade teacher, you will be asked to participate in a few data collection activities during the school year,
including video recorded classroom observations of one or more of your classes in spring 2019.
In preparation for the video observations, we will first obtain parent permission for students to be included in the
recording. A member of our local data collection team will visit your school in a few weeks to:
Obtain your daily/weekly schedule of classes. We can work from an original or copy of an accurate schedule of
classes you teach. If your schedule changes during the week, we will work with your weekly schedule.
Obtain student rosters. Working from your daily schedule of classes, we will identify classes that will be recorded.
For each of those classes, we will ask for a student roster or any full list of students (first and last names and grade)
enrolled in each class. The accuracy of this list will be very important as we will use it to track parent permission
forms indicating whether students are allowed to be recorded.
Distribute parent permission forms. During a second visit to the school, after we have finalized the list of classes
that will be recorded and the students in those classes, we will work with you to distribute parent permission packets
to students and ask them to take the packets home for their parents to review. We will check the following week to
collect returned forms from parents who choose not to allow their child to be included in recordings. Teachers will
receive $25 for helping us distribute these forms as a thank you for their efforts.
All information you provide will be kept strictly confidential (per the policies and procedures required by the
Education Sciences Reform Act of 2002, Title I, Part E, Section 183) and will not be shared with anyone outside the
study team. All forms, student lists, and video recordings will be destroyed at the end of the study.
Mathematica staff will be happy to answer any questions about the study or the information it collects. You can
contact us toll-free at [TOLL FREE NUMBER] or email us at [STUDY EMAIL]. If you have questions about your
rights as a study participant, please call the New England Institutional Review Board toll-free at 1-800-232-9570.
Thank you in advance for your help with this important study!
Sincerely,
Sheila Heaviside, Survey Director
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid
OMB control number. The valid OMB control number for this information collection is xxxx-xxxx. The time required to complete this information collection is
estimated to average one hour, including the time to review instructions and gather the data needed. If you have any comments concerning the accuracy of
the time estimate 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 content or the status of your individual submission of this form, write directly to: U.S. Department of Education, Institute of Education
Sciences, 550 12th Street, SW, Washington, DC 20202.

An Affirmative Action/Equal Opportunity Employer

OMB Number: [XXXXXX]
Expiration Date: [XXXXX]

1100 1st Street, NE, 12th Floor
Washington, DC 20002-4221
Phone: (202) 484-9220
Fax: (202) 863-1763
www.mathematica-mpr.com

Request for passive consent districts
(student assent required)

[Month, 2019]
Dear [TEACHER FIRST NAME] [TEACHER LAST NAME]:
Thank you for taking part in the Impact Evaluation of Departmentalized Instruction in Elementary Schools,
sponsored by the United States Department of Education and conducted by Mathematica Policy Research. As you
may know, [School District] is participating in this study and your school is one of [XX] schools selected to
participate during the 2018-2019 school year. The study will examine differences between elementary schools that
organize classroom instruction into self-contained classrooms (where one teacher instructs all core subjects) and
those that are departmentalized (where different teachers teach math and English/language arts). The study will
focus on fourth and fifth grade math and English/language arts classes.
As a fourth grade teacher, you will be asked to participate in a few data collection activities during the school year,
including video recorded classroom observations of one or more of your classes in spring 2019.
In preparation for the video observations, we will first obtain parent permission for students to be included in the
recording. A member of our local data collection team will visit your school in a few weeks to:
Obtain your daily/weekly schedule of classes. We can work from an original or copy of an accurate schedule of
classes you teach. If your schedule changes during the week, we will work with your weekly schedule.
Obtain student rosters. Working from your daily schedule of classes, we will identify classes that will be recorded.
For each of those classes, we will ask for a student roster or any full list of students (first and last names and grade)
enrolled in each class. The accuracy of this list will be very important as we will use it to track parent permission
and student assent forms indicating whether students are allowed to be recorded.
Distribute parent permission and student assent forms. During a second visit to the school, after we have
finalized the list of classes that will be recorded and the students in those classes, we will work with you to distribute
packets to students and ask them to take the packets home for them and their parents to review. We will check the
following week to collect student assent forms and any returned forms from parents who choose not to allow their
child to be included in recordings. Teachers will receive $25 for helping us distribute these forms as a thank you for
their efforts. Teachers who collect assent forms from 85 percent or more of their students (whether or not students
gave assent to be included in recordings) will receive an additional $25 as a thank you for their efforts.
All information you provide will be kept strictly confidential (per the policies and procedures required by the
Education Sciences Reform Act of 2002, Title I, Part E, Section 183) and will not be shared with anyone outside the
study team. All forms, student lists, and video recordings will be destroyed at the end of the study.
Mathematica staff will be happy to answer any questions about the study or the information it collects. You can
contact us toll-free at [TOLL FREE NUMBER] or email us at [STUDY EMAIL]. If you have questions about your
rights as a study participant, please call the New England Institutional Review Board toll-free at 1-800-232-9570.
Thank you in advance for your help with this important study!
Sincerely,
Sheila Heaviside, Survey Director
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid
OMB control number. The valid OMB control number for this information collection is xxxx-xxxx. The time required to complete this information collection is
estimated to average one hour, including the time to review instructions and gather the data needed. If you have any comments concerning the accuracy of
the time estimate 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 content or the status of your individual submission of this form, write directly to: U.S. Department of Education, Institute of Education
Sciences, 550 12th Street, SW, Washington, DC 20202.

An Affirmative Action/Equal Opportunity Employer