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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. • Individual instruction provided in your child’s 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 [email protected]  All of your child’s information will remain strictly confidential.  I have read this consent form and give permission for my child to participate.  Child’s name___________________________________________________  Parent signature_________________________________________________  Date__________________________________________________________ 909.537.7404 - fax:909.537.7510 5500 UNIVERSITY PARKWAY, SAN BERNARDINO, CA 92407 -2393

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Page 1: Parent Permission

8/3/2019 Parent Permission

http://slidepdf.com/reader/full/parent-permission 1/2

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.

• Individual instruction provided in your child’s 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 Bernardinounder the supervision of Dr. Stanley L. Swartz, Professor of Special Education.

Dr. Swartz can be contacted at 909.537.5601 or by email at [email protected]

 All of your child’s information will remain strictly confidential.

 I have read this consent form and give permission for my child to participate. 

Child’s name___________________________________________________ 

 

Parent signature_________________________________________________ 

 

Date__________________________________________________________ 

909.537.7404 - fax:909.537.7510

5500 UNIVERSITY PARKWAY, SAN BERNARDINO, CA 92407 -2393

mailto:[email protected]
http://us.mg2.mail.yahoo.com/ya/download?fid=Inbox&mid=1_82394_AMvsjkQAALkgSWgMNA2%2FKGRi2wA&pid=2&tnef=&YY=1231822608953&newid=1&clean=0&inline=1
mailto:[email protected]
Page 2: Parent Permission

8/3/2019 Parent Permission

http://slidepdf.com/reader/full/parent-permission 2/2

COLLEGE OF EDUCATION 

SPECIAL EDUCATION PROGRAM 

 Formulario de Consentimiento de los padres

 Nombre del maestro/a: _______________________ 

Llámeme al: _______________________________ 

 Su hijo/a fue seleccionado para recibir enseñanza especial en lectura y escritura como

 parte de mi formación profesional para ser un mejor maestro/a. Esta actividad incluirá losiguiente:

• Evaluación especial para determinar como ayudar a su hijo/a mejorar sus

habilidades de lectura y escritura.

• Enseñanza en grupo pequeño proporcionada en el salón de clase de su hijo/a.

Estas sesiones serán grabadas para repasar y evaluar mi estilo de enseñanza. Estas

grabaciones serán utilizadas en mi clase en California State University, San Bernardino bajo la supervisión del Dr. Stanley L. Swartz, Profesor de educacion especial.

Dr. Swartz con quien se puede comunicar al 909.537.5601 o por correo electrónico al

[email protected]

 

Toda la información de su hijo será totalmente confidencial.

 He leído el formulario de consentimiento y dado permiso para que mi hijo/a participe.

  Nombre del nino___________________________________________________ 

 

Firma del padre____________________________________________________ 

 Fecha____________________________________________________________ 

909.537.7404 - fax:909.537.7510

5500 UNIVERSITY PARKWAY, SAN BERNARDINO, CA 92407 -2393

mailto:[email protected]
mailto:[email protected]

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