Parental Information and Opt-Out Form

[School Letterhead]

OMB Control Number XXXX-XXXX (Exp XX/XX)

August XX, 2014

Dear Parent or Guardian:

[Insert high school] is committed to helping our students graduate college and career ready. As 

part of our commitment, we are working with the Regional Educational Laboratory (REL)

Midwest to study a schoolwide guidance program called Ramp-Up to Readiness (“Ramp-Up”). 

Scholars at the College Readiness Consortium at the University of Minnesota developed RampUp based on existing research.

The purpose of this letter is to let you know that we plan to release some information about the 

students in [high school] to REL Midwest and that your son or daughter may be asked to 

complete a survey and college-readiness assessment. The information provided to REL Midwest 

will not include student names or any other personally identifiable information about you or your 

child. In other words, the data will be anonymous to the researchers. 

Parents and students should understand the following:

This anonymous information will help the research team better understand the challenges that 

schools have in carrying out Ramp-Up and the experiences students have when participating in 

Ramp-Up activities. 

The anonymous information will include students’ grades, test scores, course enrollments, 

college enrollment activities, and the student identification number used by the Minnesota 

Department of Education. The researchers will be able to use your son’s or daughter’s 

identification number to obtain other information from state databases, such as test scores, but 

they will be unable to link that number with your child’s identity. 

As part of the study, your son or daughter may be asked to do the following:

 Take surveys during the fall and spring that asks about his or her experiences at school 

with planning and preparing for life after high school.

 Take an online college-readiness assessment (ACT’s ENGAGE assessment) in the fall 

and spring. This assessment will measure students’ motivation and skills, social 

engagement, or self-regulation.

 No student has to answer questions on the surveys or assessments that he or she does not 

want to answer.

 All information about your child will be anonymous. The information collected will only 

be used for this research project, and the researchers will average the data for all students 

and all participating schools. They will report these averages in government reports and 

research articles, but readers will be unable link those findings with individual students, 

teachers, or schools.
Parental Information and Opt-Out Form

[School Letterhead]

OMB Control Number XXXX-XXXX (Exp XX/XX)

 Risks: This study presents minimal risk to your child. That is, students do not experience 

any risks beyond what they experience every day at school. 

 Benefits: Study participation helps build knowledge about how to better support students 

to be college or career ready.

 Participation in the study is voluntary. Students do not have to participate if they do not 

want to, and they will experience no repercussions at school if they decide not to 

participate. Our school’s participation in this research study helps educators learn more 

about how schools can help students become college and career ready.

If you do not wish us to release anonymous information for your child or have your child 

complete the surveys and assessments, please fill in the form below and have your son or 

daughter return this letter to [return location] by [deadline].

If you have questions about this research project or about your child’s rights as a participant, 

please contact Jim Lindsay of REL Midwest at 630-649-6591.

Sincerely,

[insert district signatory]

By signing this form, you are indicating that you do not wish your child to participate in the 

study or for us to share your child’s information with the REL Midwest research team.

I do NOT want my child, __________________________________________,

Full Student Name

(Student ID # _____________________) to participate in the Ramp-Up evaluation being 

conducted by REL Midwest.

Your name: ______________________________________________________

Your signature: ___________________________________________________

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB 

control number. The valid OMB control number for this information collection is 1850-XXXX, OMB expiration date is XXXX, XX, 2017. The time 

required to complete this information collection is estimated to average 5 minutes per respondent, including the time to review instructions, gather the 

data needed, and complete and review the information collected. 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, Washington, DC 20202. If you have comments or concerns 

regarding the status of your individual submission of this form, write directly to: U.S. Department of Education, Institute of Education Sciences, 555 

New Jersey Avenue, NW, Washington, DC 20208.