Explicit Parent Consent Form

Program for International Student Assessment (PISA 2009)

Field Test

Parent/Guardian Consent Form

Your child has been asked to participate in a field test of an international study of student learning called the Program for International Student Assessment (PISA). This assessment will be conducted by a team of researchers from Westat Corporation, who are operating under contract with Windwalker Corporation on behalf of the U. S. Department of Education. In the Spring of 2008, new reading items will be tested in approximately 35 schools and with approximately 1,200 students in the United States. This field test will allow test developers to modify or delete items that are not working effectively. The study needs your permission for your child to take part.

Confidentiality

Every precaution will be taken to protect your child’s privacy. Your child’s name will never be associated with any results that are reported from the field trial. Only group-level findings will be presented in any reports or other documents that are created as part of the assessment. No individually identifiable results will be presented.

Your Child’s Rights

1. Your child’s participation in the assessment is completely voluntary. However, we encourage each student selected take part in the field test. Each time a selected student does not participate, the accuracy of the U.S. information suffers. Refusal to participate will not affect your child’s opportunities in high school. You or your child may decide not to participate.

2. The assessment will last for about 3 hours.

3. Your child will be given a $20 stipend at the completion of the assessment in appreciation for his or her contribution.

4. If you have any questions about PISA or your child’s rights as a study participant, you can contact PISA at 1-888-270-6227 or [email protected].

5. You will be given a copy of this form to keep.

Signature of Parent: _______________________________________________

Name of Student: ________________________________________________

Street Address ___________________________________________________

City _____________________________ Zip code ______________________

Telephone ______________________________________

Date____________________________________________

FOR OFFICE USE ONLY:

Student ID: ________________________________________________