Informed Consent Form and Authorization for a Minor to Serve as a Research Participant

Dear Mr. and Mrs. McGuigan, I will be conducting a study in the pre-school classroom to determine how our teachers can use video tape for assessment of preschool learning and to inform parents of their childs learning progress. Participation in this study involves regular classroom observations and video collection of tasks that we are currently already doing by written assessments. There are two purposes of this study, the first purpose is to take our current assessment tool, Work Sampling and supplement it with video of children developing the targeted skill or task. The second purpose is to help teachers communicate better with parents during parent-teacher conferences. The study will take place here at Aardvark Day Care and will last for 4 to 6 weeks. The procedures that I will follow are: to examine the teachers current assessment and effectiveness, to identify the childs assessment on video tape and inform the parent of the childs learning progress. During the study, I will collect various forms of data to determine whether video assessment was successful. Possible types of data I will collect are surveys/ questionnaires, interviews, observations and video. This study will not interfere with your childs daily learning experiences or with our current assessment practices. There are no risks to your child or to you as participants in this study. Benefits of participating in this study include: (a) the teacher being able to refer back to the childs progress in order to continue to design effective instruction for children and (b), the parents are able to view their child during the learning process and see how we are assessing their child, beyond a check mark on Work Sampling. Your childs participation in this project is strictly confidential. Last names will not be used and this study is completely voluntary. Your participation in surveys and interviews is also voluntary. You may contact me at any time if you do not wish to have your childs data included in the study, without penalty to you or your child. I can be reached at 484-557-6770. Please check the appropriate box below and sign the form:

I give permission for my childs data to be used in this study. I also give consent to participate in this study through interviews and surveys. I understand that last names will not be used in the final study reports. I understand that I will receive a signed copy of this consent form. I have read this form and understand it. I do not give permission for my childs data to be included in this project.
______________________________ Students name _______________________________ Date ______________________________ Signature of parent/guardian