Boulder Valley School District

JRSU-E

  • J
  • Students

File: JRSU-E (pdf)
Adopted: Date of Manual Adoption


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).

CONSENT FORM FOR SUBMISSION TO A SURVEY,
ANALYSIS, OR EVALUATION 

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                                                                          
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                                                            
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.


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