Active Consent Form

EVALUATION OF READING COMPREHENSION PROGRAMS
U.S. DEPARTMENT OF EDUCATION
PARENT PERMISSION FORM

I GIVE PERMISSION for my child, _______________________________________ (name of child),
to complete reading tests this year and (if Caddo Parish decides to participate in an optional second
year of the study) next year. I give permission for my child’s school to provide requested information
about my child for research purposes.
I DO NOT GIVE permission for my child, __________________________________ (name of child),
to participate in the Evaluation of Reading Comprehension Programs.

SIGNATURE OF PARENT OR GUARDIAN
DATE

YOUR FULL NAME (PLEASE PRINT)
CHILD’S FULL NAME (PLEASE PRINT)
CHILD’S SCHOOL
CHILD’S ENGLISH/LANGUAGE ARTS TEACHER

DATE OF BIRTH