COLLEGE OF EDUCATION SPECIAL EDUCATION PROGRAM

Parent Consent Form

Teacher name:_______________________ Contact me at:_______________________
Your child has been selected to receive special support as part of my training to become a better teacher. This activity will include the following: Special assessments to determine how best to help your child improve his or her reading and writing skills. Individualinstruction provided in your childs classroom.

These sessions will be recorded to review and evaluate my teaching. These tapes will be used in my class at California State University, San Bernardino under the supervision of Dr. Stanley L. Swartz, Professor of Special Education. Dr. Swartz can be contacted at 909.537.5601 or by email at sswartz@csusb.edu All of your childs information will remain strictly confidential. I have read this consent form and give permission for my child to participate. Childs name___________________________________________________ Parent signature_________________________________________________ Date__________________________________________________________

909.537.7404 - fax:909.537.7510 5500 UNIVERSITY PARKWAY, SAN BERNARDINO, CA 92407 -2393