PERMISSION TO PARTICIPATE IN PROGRAM & DATA COLLECTION

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Date *

YYYY

Student Name *

School Site *

Please check the appropriate statement below. *

I give permission for my child to participate in the universal social, emotional and behavioral screening process and data collection.

I do not give permission for my child to participate in the universal social, emotional and behavioral screening process.

I understand that I will be notified and will be required to provide written informed consent prior to any intervention or other social, emotional and behavioral services are provided for my child.

By typing my name below, I am confirming that I have read the below PPRA and FERPA statements and have been informed of my rights under PPRA and FERPA. *

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