Consent Form for Records Release

Evaluation of Strategies to Address Unfinished
Learning in Math (ReSolve Math Study)
Appendix G
Parent/Guardian Consent Form for the Release of Records

May 2023

ReSolve Math Study
Student Records Parent/Guardian Consent Request
2023/2024/2025

Notice of Confidentiality
Information collected for this study comes under the confidentiality and data protection requirements of the Institute of
Education Sciences (The Education Sciences Reform Act of 2002, Title I, Part E, Section 183). Responses to this data
collection will be used by the U.S. Department of Education, its contractors, and collaborating researchers only for
statistical purposes. Reports will summarize findings across the sample and will not associate responses with a specific
school or student. All of the information you provide may be used only for statistical purposes and may not be disclosed, or
used, in identifiable form for any other purpose except as required by law (20 U.S.C. §9573 and 6 U.S.C. §151).
Paperwork Reduction Act of 1995
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless
such collection displays a valid OMB control number. The valid OMB control number for this information collection is xxxxxxxx. The time required to complete this voluntary information collection is estimated to average 10 minutes, including the
time to review instructions and complete and review the information prompted. If you have any comments concerning the
accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education,
Institute of Education Sciences 550 12th Street, SW, Washington, DC 20024.

ReSolve Active Consent
Dear Parent or Guardian:
Your child’s school is participating in a national study, the ReSolve Math Study, to understand how digital math
programs can improve 4th and 5th grade students’ math education, in addition to existing teacher-led math
instruction.
The study is being led by MDRC (a nonprofit, nonpartisan research organization that has been doing work in the
education and social policy field since 1974). Data collection is being conducted by Westat (a research firm with
expertise in data collection in education and other areas since 1963). The study is funded by the U.S.
Department of Education.
This form asks you to give permission, that is “consent,” for the study team to collect information on your
child from their school records. It is important for you to read and understand the following information:
•

•

•
•

•

Your child’s participation in the study will help teachers and school leaders learn how to support
students’ math learning. If you consent to your child’s participation, the study team will request
information from the school or district about your child’s background characteristics (e.g., whether they
are an English Language Learner), performance on math assessments (e.g., performance on state
standardized math tests), and math course-taking in future years (e.g., grades and completion of
advanced math courses). The study will collect information about your child’s characteristics and
academic performance during the previous school year, the current school year, and through the end of
high school. Additionally, this information will be linked to other information about your child’s school
such as its size.
Participation in the study presents very few risks or burdens to you or your child. As noted above, we
will collect and store your child’s school records for many years, which are already being stored by the
school and district. We will take every precaution to make sure the information is not lost, stolen, or
misused. There are no direct benefits, though your input will help make programs like this stronger for
families like yours. MDRC’s Institutional Review Board (the entity that protects individuals who
participate in research studies) has reviewed and approved the study procedures.
Participation in the study is voluntary. You or your child may decide not to share (that is, opt out) your
child’s information with the study team at any time by emailing [email protected]. Doing so will
not have any negative consequences for your child or the instruction they receive.
All information collected for this project is fully protected by the confidentiality and data protection
requirements of the U.S. Department of Education’s Institute of Education Sciences, as required by the
Education Sciences Reform Act of 2002 (Title I, Part E, Section 183). The data that researchers collect will
be used only for research purposes. The study reports will not reveal information about you or your
child. MDRC and Westat use strict data security practices to protect the privacy of all information we
collect. We will remove your child’s name and student identification number from the data we collect
and will store all collected data in a separate, secure location. Access to this information will be
restricted to members of the research team. We will not report any information that identifies your
child.
The study team will store unidentifiable information collected as part of this study in a restricted use file
(that is, a data file that does not include names or identifiers of any study participant). This information
may be used for other studies in the future without additional informed consent from you or your child.

Please complete the form on the next page by << DATE>> to provide consent or to opt out of sharing your child’s
student record information with the study team. If most of the students in your child’s class return a form, the
class will be eligible to receive a gift from the study as a thank you. If you have any questions, please contact the
study team at [email protected] or <>.

Parent/Legal Guardian Permission Form
Please let us know if you will or will not permit the study team to collect information from the school or district
about your child’s background characteristics, performance on math assessments, and math course-taking in
future years. Please return this form to your child’s teacher by <<>> or scan the QR code below to
submit this permission digitally. If most of the students in your child’s class return a form, the class will be
eligible to receive a gift from the study as a thank you.

CHILD NAME:

_______________________________________________________________________

SCHOOL NAME: _______________________________________________________________________

GRADE:

_______________________________________________________________________

Please SIGN ONE only:
I GIVE PERMISSION for the study team to receive school and district data as described above on my child:
SIGNATURE: ______________________________________ Date: ___________________

I DO NOT GIVE PERMISSION for the study team to receive school and district data on my child:
SIGNATURE: _______________________________________ Date: ___________________

THANK YOU!
If you have concerns or questions about this project, please contact the study team at [email protected]
or <>.

ReSolve Passive Consent
Dear Parent or Guardian:
Your child’s school is participating in a national study, the ReSolve Math Study, to understand how digital math
programs can improve 4th and 5th grade students’ math education, in addition to existing teacher-led math
instruction.
The study is being led by MDRC (a nonprofit, nonpartisan research organization that has been doing work in the
education and social policy field since 1974). Data collection is being conducted by Westat (a research firm with
expertise in data collection in education and other areas since 1963). The study is funded by the U.S.
Department of Education.
If you are okay with your child’s participation, you do not need to complete a form; if you will not permit the
study team to collect information on your child, please fill out the form on the next page.
It is important for you to read and understand the following information:
•

•

•
•

•

Your child’s participation in the study will help teachers and school leaders learn how to support
students’ math learning. The study team will request information from the school or district about your
child’s background characteristics (e.g., whether they are an English Language Learner), performance on
math assessments (e.g., performance on state standardized math tests), and math course-taking in
future years (e.g., grades and completion of advanced math courses). The study will collect information
about your child’s characteristics and academic performance during the previous school year, the
current school year, and through the end of high school. Additionally, this information will be linked to
other information about your child’s school such as its size.
Participation in the study presents very few risks or burdens to you or your child. As noted above, we
will collect and store your child’s school records for many years, which are already being stored by the
school and district. We will take every precaution to make sure the information is not lost, stolen, or
misused. There are no direct benefits, though your input will help make programs like this stronger for
families like yours. MDRC’s Institutional Review Board (the entity that protects individuals who
participate in research studies) has reviewed and approved the study procedures.
Participation in the study is voluntary. You or your child may decide not to share (that is, opt out) your
child’s information with the study team at any time by emailing [email protected]. Doing so will
not have any negative consequences for your child or the instruction they receive.
All information collected for this project is fully protected by the confidentiality and data protection
requirements of the U.S. Department of Education’s Institute of Education Sciences, as required by the
Education Sciences Reform Act of 2002 (Title I, Part E, Section 183). The data that researchers collect will
be used only for research purposes. The study reports will not reveal information about you or your
child. MDRC and Westat use strict data security practices to protect the privacy of all information we
collect. We will remove your child’s name and student identification number from the data we collect
and will store all collected data in a separate, secure location. Access to this information will be
restricted to members of the research team. We will not report any information that identifies your
child.
The study team will store unidentifiable information collected as part of this study in a restricted use file
(that is, a data file that does not include names or identifiers of any study participant). This information
may be used for other studies in the future without additional informed consent from you or your child.

You do not need to do anything if you are okay with the study team receiving school and district data about
your child. If you do not wish to have the study team receive your child’s data, the following page contains a
form for you to complete. Please contact the study team with any questions you may have at
[email protected] or <>.

Parent/Legal Guardian Form
Please let us know if you will not permit the study team to collect information from the school or district about
your child’s background characteristics, performance on math assessments, and math course-taking in future
years. Please return this form to your child’s teacher by <<>> or scan the below QR code to fill out and
submit the form digitally. You do not need to fill out this form or take any action if you are okay with the
district sharing existing data about your child with the study’s team.

CHILD NAME:

_______________________________________________________________________

SCHOOL NAME: _______________________________________________________________________

GRADE:

_______________________________________________________________________

I DO NOT GIVE PERMISSION for the study team to receive school and district data on my child:
SIGNATURE: _______________________________________ Date: ___________________

THANK YOU!
If you have concerns or questions about this project, please contact the study team at [email protected]
or <>.