Boulder Valley School District

JFJ-E

  • J
  • Students
JFJ-E

File:   JFJ-E (pdf)
Adopted:   

CONSENT FOR SUBMISSION TO SURVEYS, ANALYSES, OR EVALUATIONS

In some circumstances in which a student is to be required to submit to a survey, analysis, or evaluation, the school must receive written parental consent prior to the activity.  

A "survey," "analysis," or "evaluation" means a method of obtaining information, including a group activity, that is designed to elicit information about one or more of the following seven protected areas:

  1. political affiliations;  
  2.  mental and psychological problems potentially embarrassing to the student or his or her family;  
  3.  sex behavior and attitudes;
  4.  illegal, anti-social, self-incriminating, and demeaning behavior;  
  5.  critical appraisals of other individuals with whom respondents have close family relationships;  
  6.  legally recognized privileged and analogous relationships, such as those of lawyers, physicians, and ministers; or  
  7.  income (other than that required by law to determine eligibility for participation in a program or for receiving financial assistance under such program).  

 

 

 

 


(Complete form on next page)

 


On ____________________, your child will be asked to __________________________

_______________________________________________________________________.

Please complete this form and return to ______________________________ School by

____________________. Feel free to call _________________________ at __________ if

you wish to discuss this activity before signing the form.  

____ I give my consent for _________________________  (student's name)  to participate in a survey,   analysis, or evaluation, as described above.  I understand that my student may choose not to respond to any portion of, or withdraw from the activity at any time.  

____ I do not give my consent for _________________________ (student's name)  to participate in a survey, analysis, or evaluation, as described above.  I understand that my student will be given an academic alternative in a manner that does not call particular attention to my student or my student's family.  

_________________________________________________________________________
Signature of Parent/Guardian (or of Student if an emancipated minor or 18 years of age or older)  


End of File: JFJ-E