Video Consent Letter

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This semester a student teaching candidate, Mrs. Alana Barrett from The University of Alabama in Huntsville will be in Mrs. Breeden's classroom. This student is required to perform tasks to pass certification criteria in edTPA, a teacher certification program. The student teacher candidate will not release any identifying information such as, a students name, the teachers name, the school name or the school location. The video segment needed will be kept in a secure location and will only be shared between the student teacher and the edTPA program. This video is a crucial step for Mrs. Barrett in her certification process. Below is the letter for you to read with more information. Please read the letter and then fill out the questions with your personalized responses.

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Student Name

Student's Date of Birth:

YYYY

Street Address:

City/State/Zip Code:

School:

Liberty Middle School

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Teacher:

Mrs. Breeden

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I am the parent/legal guardian of the child named above. I have received and read the letter regarding a teacher assessment being conducted by the University of Alabama in Huntsville, and agree to the following: (Please select either I DO or I DO NOT below.) Your child will not be penalized if you choose: "I DO NOT give permission."

I DO give permission to include my child's image on video recordings as he or she participates in class conducted at my child's school by the aforementioned institution and/or to reproduce materials that my child may have completed as part of the classroom activities. No student's name will appear on any materials submitted by the student teacher.

I DO NOT give permission to video record my child or reproduce materials that my child may have completed as part of classroom activities.

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Parent Signature:

Date of Completion:

YYYY

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