Parental Permission for Student’s Participation in a

Science Grade 5 Cognitive Interview

The purpose of this form is to provide you, the parent, with information that may affect your decision
about your child’s participation in a study for the Elementary-level Science assessment. Please read the
information below and reach out to your child’s educators with questions.

Purpose of the Evaluation

If you agree, your child will be asked to participate in a short study using test items from the
Elementary-level Science assessment. The purpose of this study is to help the New York State Education
Department better understand the concepts being measured by this assessment. Your child will not be
evaluated on their achievement in science; rather, we will use your child’s responses to evaluate how
well the test questions measure science concepts included in the New York State P-12 Science Learning
Standards.

What is my child going to be asked to do?

Your child, as one of six (6) students in Grade 5 participating in the study, will be asked to read and respond to six (6)
test items from the Grade 5 Elementary-level Science assessment.
Two evaluators from edCount will interact with your student. Your student will participate in a think-aloud protocol
while answering the test items, telling the evaluators what they are thinking. Your student will also answer any
questions the evaluators have regarding their thought processes while responding to each question.
This study will take approximately two hours to complete and will take place during regular school
hours. Care will be taken to ensure your child does not miss critical class instruction.

Your child will be audio recorded but at no time will your child’s identity be revealed in the study
findings.

What are the risks involved in this evaluation?

There are no foreseeable risks to participating in this evaluation.

Does my child have to participate?

No, your child’s participation is voluntary. Your child may decline to participate or withdraw from
participation at any time. Withdrawal or refusing to participate will not affect their relationship with the
school or school district in any way. You can agree to allow your child to be in the evaluation now and
change your mind later without any penalty.

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How will my child’s privacy and confidentiality be protected if they participate in this evaluation?
Your child’s privacy and the confidentiality of their data will be protected by removing all identifying
information from the final report. Your child’s name, school, and district will not be included in the
report.

The interactions between the student and evaluators will be audio recorded. All audio recordings will be
stored securely and only the evaluation team will have access to the recordings. The recordings will be
deleted after six months.

Who do I contact with questions about the evaluation?

You can contact the lead evaluator, Dr. Melissa Fincher, at mfincher@edcount.com with any
questions or if you feel that you or your child has been harmed. This evaluation has been reviewed
and approved by the New York State Education Department.

Signature
Your signature below indicates that you have read the information provided above and you have
decided to allow your child to participate in the evaluation. If you later decide that you wish to
withdraw your permission for your child to participate in the evaluation, you may discontinue his or her
participation at any time.

Printed Name of Child

Signature of Parent(s) or Legal Guardian Date