CONSENT

I, _____________________________________, a SPED teacher in

___________________________________, have read, comprehended, and had a chance to ask
questions about the information provided. I am aware that participation is totally voluntary and
that I am free to discontinue at any time, for any reason, and without incurring any costs. I am
aware that a copy of this permission form will be given to me.

Teacher’s signature ______________________________ Date ______________

Researcher’s signature ____________________________ Date ______________