Tech Survey Parent Permission Form

Tech Survey Parent Permission

Parental Consent for Minor Student Form

One to One Effectiveness

Parental Informed Consent

I, , agree to allow my son/daughter to participate in the research study titled “The Perceived Effectiveness of One-to-One Technology in Smallwood High School” I understand the research will be conducted by Jason Clemensen Education Doctorate Student at the University of Arkansas, and that my child’s participation is voluntary.  I understand that at any time I may stop my child’s participation or my child may stop their participation in the study without penalty.  I understand that my child may also decline to answer any survey questions that they feel uncomfortable answering.  I understand that at any time I can ask the researcher to delete or destroy all information from the research records and/or return any information collected about my child.


The purpose of this study will be to conduct a qualitative study of the effectiveness of a one to one initiative in a 9-12 High School in the Midwest.  The interview data collected would be analyzed to determine common themes in classroom usage and implementation strategies.  Interview data would also be analyzed to determine common themes of success versus failures of the one to one initiative.  Survey data collected would be analyzed to determine common themes from students towards the benefits or restrictions of the one to one program.  Observation data collected would be used to gain visual data of the effectiveness of one to one programs.


If I allow my child to volunteer to take part in this study, he/she may be asked the following things:


1)     To take a survey that addresses the one to one environment in my high school


My child will not receive any monetary compensation for participation in this study.  I understand that survey questions may address sensitive topics and difficult subject matter; I understand that at any time my child can choose to not answer said questions.  I understand that all information will be kept strictly confidential to the extent of the law and University policy.


I understand all information collected will be stored on the researchers password protected computer.  Unless required by law, no individually identifiable information will be shared.  As a participant I understand that my child’s school’s name will not be used in the study, the city of my child’s school will not be used in the study, and my child’s name will not be used within the study.  I understand that student data will only be used as a whole, there will be no individual student responses or names used.  I understand that geographic region will be used to describe my school ex. Rural Midwest.  If I provide any identifying remarks, they will be removed from the transcript.  I understand that my child will not be asked to provide my name on the survey.  The researcher will answer any further questions about the research now or during the course of the project.


I understand that by signing this form I am agreeing to allow my child to take part in this research project and understand that I will receive a signed copy of this consent form for my records.


For questions about your child’s rights as a research participant please call or write:


Iroshi Windwalker

Compliance Coordinator, 201 Administration Building, Fayetteville, Arkansas 72701

Telephone (479)575-2208

E-mail Address

Name of Researcher: Mr. Jason Clemensen

Researcher’s Telephone: (620)704-3359

Researcher’s Email:

Parent Signature: Date: