TEMPLATE Parent Opt Out Letter

Dear Parent or Guardian: 

As part of our efforts to continually improve our student support systems and school climates, your student is being asked to participate in a pilot survey to help us better understand how students’ perceptions about academic behaviors, learning strategies, and their school and classroom environments relate to academic achievement.  

While student IDs will be attached to the survey data, we will not look at individual responses but rather explore how patterns of responses are linked to student outcomes. If you would prefer that your student not take the survey, please fill out the form below and return it to your child’s school. 

The survey will be administered on [DATE OF SURVEY ADMINISTRATION] during your child’s [NAME] class. The survey has 21 quantitative items and 2 qualitative items to gauge social-emotional learning with additional grade-appropriate items about college and career readiness; it is expected to take 30 minutes to complete. 

If you have any questions about this survey, please call  [INSERT NAME AND PHONE NUMBER OF DISTRICT CONTACT]. 

To view the survey, please visit: 

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Withdrawal Form 

By returning this form, I do not give permission for my child to participate in this survey. 

My child’s name is:   ____________________________________________________________                                                 

Grade:  _____________________________________________________________  

Teacher’s name or Class subject:   __________________________________________________   

Signature:     _____________________________________________________________    

Date:        _______________________________________________________________________