Informed Consent Ede 611

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Saint Laurence School

8245 West Chester Pike


Upper Darby, Pa 19082-1319

February 6, 2017

Dear Parents and Guardians,

I am a graduate student in the Department of Early and Middle Grades Education at West Chester
University of Pennsylvania, working toward my M.Ed. in Applied Studies in Teaching and Learning. As
part of my Masters degree program, I will be conducting an action research assignment to understand the
benefits to our school climate with the implementation of our positive behavior plan, SOAR.

I would like to include your child in my research project. I have discussed my research with Sr.
MaryAnne Bolger and your childs teacher.

During a period of 6-8 weeks, I will be observing the students throughout the school. As students
participate in SOAR, I will be collecting data by recording observations about student participation,
interviewing students, surveying students, and interviewing fellow elementary teachers.

All data that I collect (observations, interviews, and surveys) will be kept confidential and no references
to students names will be used in my work at any time. All information that is obtained during this
research project will be kept strictly secure. Child confidentiality is most important and every effort will
be made to be sure that this research remains confidential at all times.

The results of this study will be used for an online website that is required in my course, Teacher as
Classroom Researcher, in the College of Education at WCU. Pseudonyms will be substituted for the
names of students included in my research. The website used to present my research is a password-
protected site, viewable by me, classmates, and my professor only.

If you are willing to allow your childs participation, please return the following form by
February 10, 2017. If you have any questions, feel free to contact me at
Kimberlybacher@saintlaurence.org.

Sincerely,

Ms. Kimberly Bacher

______________________________________________________________________________

I agree to for my child to participate in this research and I understand that observations, survey responses
or interviews from my child will be included, anonymously. I understand there is no risk to my child, and
that I may withdraw my consent at any time, without penalty.

Childs Name:______________________________________________
Grade:______________

Parent Signature:___________________________________________ Date:________________

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