Hello Parents/Guardians!

My name is Jessica Dammen and I am a

Winona State University student. I am currently
working on my last semester to earn my Bachelors
degree in Elementary Education in order to receive
my teaching license. As a requirement of Winona
State University I will be completing ten weeks of
student teaching in your childs classroom with Erik
LaRock. I am excited to have the opportunity to work with and get to
know your child over the next few months.

I officially start my ten weeks January 9 th, 2017 and will end my
student teaching experience on March 24th, 2017. Over the course of
ten weeks I will be observing and assisting in the classroom as well as
getting to know the students. I will gradually take on the
responsibilities of teaching and will ultimately work up to teaching full
time for two weeks. I will then be transitioning out of the classroom
towards the end of March.

To complete my teacher licensing program, I am expected to

submit a video of myself teaching and student work. All information
that I collect will be kept completely confidential and will only be
shared with my university professor. Included with this letter is the
consent to participate form. If you have any questions, please do not
hesitate to ask.

Thank you,
Jessica Dammen
Jessica.Dammen@austin.k12.mn.us
Teacher Performance Assessment Student
Consent to Participate
Dear Parent/Guardian:
I am a Teacher Candidate from Winona State University. I am doing my student teaching in your
childs class. To complete my teacher licensing program, I need to submit a video of myself
teaching and some examples of work that the students have completed as part of the Teacher
Performance Assessment. I am asking for your permission to include your child in the video of my
teaching and to include your childs class work in my Teacher Performance Assessment.

The video and the students work will be:

Kept confidential (all names will be removed from the students work)
Used to assess my performance as a teacher, not your childs performance
Viewed in my teacher licensing program courses for feedback to me to improve my teaching
Submitted to be scored by trained scorers through a password protected website
Possibly selected to train future scorers of the Teacher Performance Assessment
Destroyed and deleted when they are no longer needed for the Teacher Performance
Assessment

If you choose to not allow your childs image and work to be included in the Teacher Performance
Assessment, he or she will still have instructional activities on the same learning goals as all other
students. Thank you for this opportunity to learn to teach with your childs teacher and for allowing
me to become an effective teacher by closely studying myself teaching through this performance
assessment.

Sincerely,

_______________________________
(Teacher Candidate Signature)
-------------------------------------------------------------------------------------------------------------------------------------------
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CONSENT by Parent or Guardian of students under 18 years old

I am the parent/legal guardian of the child named below. I understand the use of my childs image,
voice, and work samples for the Teacher Performance Assessment as described in the letter above.

_____ I DO give permission to include my childs image and voice on video recordings and my childs
regular classroom work for the Teacher Performance Assessment.
_____ I DO NOT give permission to video my child or to use my childs classroom work for the
Teacher Performance Assessment.

Students name: __________________________________ Students School:

_______________________________

Signature of Parent or Guardian: _________________________________ Date:

____________________________

CONSENT by students more than 18 years old

I understand the use of my image, voice, and work samples for the Teacher Performance
Assessment as described above.
_____ I DO give permission to include my image and voice on video recordings and my regular
classroom work for the Teacher Performance Assessment.
_____ I DO NOT give permission to video me or to use my classroom work for the Teacher
Performance Assessment.

Students name: __________________________________ Students School: ___________________________

Signature of Student: ___________________________ Date: _________________ Date of

Birth: ___/___/___