APPENDIX R_Summary of School Arrangements Form_OMB

APPENDIX R

Active and Passive Summary of School Arrangements Form

Active Summary of School Arrangements Form

Code

XXXX

CRIME PREVENTION THROUGH ENVIRONMENTAL DESIGN (CPTED) STUDENT SURVEY

SUMMARY OF SCHOOL ARRANGEMENTS FORM

Please review the information below for accuracy. If there are any changes, record them and fax the corrected form to Rená Agee at 301-572-0986, call our toll-free line at XXX-XXX-XXXX, or email [email protected].

School Name:

School Address:

Name and Phone of Main Contact:

Scheduled Date(s) of Data Collection:

District/County Name:

School Phone:

Principal Name:

Name and Phone of Alternate Contact:

Time and Place of Teacher/Principal Meeting:

I. SELECTED CLASS SECTIONS:

Grade	Name of Teacher	Type of Class	No. of Students	Class Period	Start Time	End Time	Date of Data Collection

II. PARENTAL PERMISSION FORMS: Type: Active

Teachers:  Your school has selected the Active Parental Permission form. This form must be returned by all students in your class signed by a parent. Only those students with a form marked "yes" may participate in the survey.  High student participation rates are critical for valid survey results.   Please (1) encourage students to return the signed forms promptly; (2) track and retain signed forms; and (3) send home reminder forms, if needed.   We appreciate your assistance and support of this important survey.

III. SUGGESTED MEANS TO MAXIMIZE PARTICIPATION:

 School bulletin/newsletter  Student encouragement from principal and teachers

 PTA newsletter/announcement  Telephone tree

 Discussion in teachers meeting  Other:

 Letter sent home from principal

IV. SPECIAL REQUIREMENTS/SUGGESTIONS:

Passive Summary of School Arrangements Form

Code

XXXX

CRIME PREVENTION THROUGH ENVIRONMENTAL DESIGN (CPTED) STUDENT SURVEY

SUMMARY OF SCHOOL ARRANGEMENTS FORM

Please review the information below for accuracy. If there are any changes, record them and fax the corrected form to Rená Agee at 301-572-0986, call our toll-free line at XXX-XXX-XXXX, or email [email protected].

School Name:

School Address:

Name and Phone of Main Contact:

Scheduled Date(s) of Data Collection:

District/County Name:

School Phone:

Principal Name:

Name and Phone of Alternate Contact:

Time and Place of Teacher/Principal Meeting:

I. SELECTED CLASS SECTIONS:

Grade	Name of Teacher	Type of Class	No. of Students	Class Period	Start Time	End Time	Date of Data Collection

II. PARENTAL PERMISSION FORMS:

Type: Passive

III. SUGGESTED MEANS TO MAXIMIZE PARTICIPATION:

 School bulletin/newsletter  Student encouragement from principal and teachers

 PTA newsletter/announcement  Telephone tree

 Discussion in teachers meeting  Other:

 Letter sent home from principal

IV. SPECIAL REQUIREMENTS/SUGGESTIONS: