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1.00 Student Release Form

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Last updated about 3 hours ago
3 questions
Note from the author:
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Students: Please complete this form with your Learning Coach.

Students: Please complete this form with your Learning Coach.

Dear Learning Coach & Student:

I am a participant this school year in an assessment to certify teachers as accomplished practitioners in teaching. My participation in this assessment, which is being conducted by the National Board for Professional Teaching Standards (the National Board), is voluntary. The primary purposes of this assessment are to make decisions about whether a teacher demonstrates knowledge and practice expected of an accomplished teacher, improve student learning and encourage excellence in teaching. This assessment requires that I submit short audiovisual recordings and/or photographs of lessons being taught in your child’s class. Although the recordings/photographs will show or involve students, the primary focus is on my instruction, not on the students. In the course of this assessment, your child’s image and voice may be recorded on the video, and your child may be photographed, with the recordings/photographs then submitted to the National Board. My submissions (the Submissions) will also include my written commentary sheets, instructional materials, essays, classroom plans, assignments, and commentary. In addition, as part of the assessment, I may be asked to submit samples of student work (the Student Work) to demonstrate my teaching practices, which could include some of your child’s work. No students’ last names will appear on any materials or in any recordings that I submit as part of my assessment. The National Board has broad rights to use my Submissions, and I assign to the National Board all of my rights in and to those Submissions. The National Board also obtains certain rights with respect to the Student Work that I submit. The National Board may use my Submissions and the Student Work, in its discretion, to further its mission of promoting excellence in education and teaching. For instance, in addition to uses related to my assessment by the National Board and any third-parties who assist in the assessment process, the National Board may post the Submissions and Student Work in a password-protected online database where they can be accessed by others for educational, research, and professional development purposes, and it may use the Submissions and Student Work in National Board works and publications. The National Board may receive fees from those to whom it grants access to the Submissions and Student Work. These uses may make my Submissions and the Student Work available for viewing by a broad range of individuals, educators, and students. Again, however, your child’s last name would not be disclosed in the Submissions or the Student Work. I am writing to request your permission for me to disclose to the National Board recordings and photographs that may include your child’s voice or image, to be used and disclosed by the National Board only in accordance with the terms of this letter and the enclosed Student Release Form. By providing permission, you will also be granting the National Board a perpetual, irrevocable and royalty-free license to use any Student Work by your child that I submit as part of my assessment, and to have and to use any copyright, rights of publicity, and other rights associated with any Student Work, and you will be releasing the National Board from all claims (including invasion of privacy) in connection with its use of the Submissions or Student Work. If you agree to your child’s participation in the activities as outlined above and the National Board’s right to use the Submissions and Student Work in the manner described in this letter, please sign the enclosed Student Release Form. I will retain this form documenting your permission and may provide it to the National Board upon request. If you do not consent to your child’s participation, your child will be out of view in making the recordings and photographs, and I will not include your child’s work in the Student Work I submit. Sincerely, Elizabeth Winer
Question 1
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Question 2
2.

Learning Coach Name & Signature

Please use the "Show Your Work" option to include a signature if your device allows.

Question 3
3.

Learning Coach E-mail

I am the Learning Coach of the student submitting this Formative. I have received and read the letter that accompanied this form (the Letter), regarding a teacher assessment being conducted by the National Board for Professional Teaching Standards (National Board), and I agree to the following:
I DO give permission to you and the school referenced above to record my child’s image and voice on video and take photographs as my child participates in a class conducted at Insight School of Washington, by Elizabeth Winer; and to provide copies of such recordings and photographs to the National Board; I also give you and the school permission to provide the National Board with copies of materials that my child has produced or may produce as part of class activities, all on the terms and conditions described below: 1. My child’s last name will not appear on or in any recordings, photographs or school works that are submitted to the National Board. 2. The National Board may use the materials that you submit to the National Board only for the purposes and on the terms described in the Letter. 3. The National Board may disclose copies of the materials that you submit to the National Board: (a) to individuals who access a National Board password-protected database for educational, research or professional development purposes; and (b) in National Board works or publications in which such materials might be included.
I DO NOT give permission to you to record my child’s image or voice or to reproduce or disclose to the National Board materials that my child may produce as part of class activities.