OST Consent forms Under 18 Participant English
.pdf
School
Reginald F. Lewis High School**We aren't endorsed by this school
Course
ELA 8404Y-1
Subject
Information Systems
Date
Dec 20, 2024
Pages
3
Uploaded by MagistrateMule4283
Would You Help Us? Permission Form to Use Your Child’sInformation in Our Program EvaluationWhat is this form? Family League of Baltimore (Family League) funds many programs in Baltimore. We want to make sure that these programs help young people. To do this, we check on (evaluate) the programs often. This form will tell you of what Family League will see if you choose to share your child’sinformation to their program. It also asks that you let us use your child’sinformation as we check on their program. What would Family League do with your child’sinformation? If you choose to share the following information to your child’sprogram, we would have access to it. You can choose to share some, all, or none of this with your child’sprogram. •Gender •Race/ ethnicity •Address School attendance: Family League also works with Baltimore City Public Schools. With your consent, we may ask them to share your child’s: •School day attendance •State test scores for math and reading •Kindergarten Readiness Assessment scores •iReady test scores
•Updated contact information for follow-ups. Surveys: With your consent, we may ask your child to fill out a survey. This survey will ask what your child thinks about this program. Your child’sanswers will help us check how the program is doing. No one will use your child’sinformation in any other way without your permission. How will you keep my child’sinformation private? If you choose to share your child’s demographic information with their program, only Family League staff and their program will look at this information. Your child’s program staff will not see your child’s survey answers or school day attendance.When we talk or write about what we learn, we will not share your child’s name. We will not share parts of your child’s information that make it easy for others to know it is your child. Instead, we will talk about information about groups of people. We will use the data you share without your child’s name to report to Family League funders. What are the risks and benefits of sharing my child’sinformation? Some people may feel uncomfortable with sharing personal information about themselves. You may choose to share your child’sinformation. You may also choose not to share your child’sinformation.If we give your child a survey, your child may choose to answer only the questions they want. Your child may also choose to answer none of the questions.No matter what, your child may still take part in their program.Here is the benefit: We hope to get information that will make this program better. You sharing your child’sinformation gives us a chance to do that. And as programs get better, they will help more people.
If you have any questions or concerns about this form, please contact us at: Family League of Baltimore 2305 N. Charles Street Baltimore, MD 21218 (410) 662-5500 DataEvaluation@familyleague.org __________________________________________________________________ I have read this Permission Form. Please check the box that shows your choice. ❑Yes, you may use my child’s information. ❑No, do not use my child’sinformation. Parent/ Guardian Sign Here: __________________________________________ Parent/ Guardian Name Here: _________________________________________Date You Signed This Form: ___________________________________________ Child’sName:_______________________________________________________ Child’s Date of Birth:_________________________________________________ Program Name:_____________________________________________________ School: ____________________________________________________________ 'SYUSK 9SOYM 9W±'SYUSK 9SOYM 9W±²³´µ¶´³µ³·)GWSKS 9SOYM²µ´µ¸´µ¹3K]Y -KS7KMOSGQI K QK]OY