Release Form for P-12 Student Participation Teacher Performance Assessment and/or Approval for Videotaping of Teacher Candidates in Practicum II Dear Parent/Guardian: I am enrolled in the Teacher Preparation program at National Louis University and am currently student teaching in your child’s classroom. My program requires that I complete a minimum of one videotaped lesson in my Practicum II experience. In the course of recording my teaching, your child may appear on the video. I will gather samples of student work to submit as evidence of my teaching practice, which may include some of your child’s work. This is not an assessment of your child’s performance. This is an assessment of the instruction required for me to obtain a teacher’s license. No student’s name will appear on any materials that are submitted, and materials will be kept confidential at all times. The video recordings and student work I submit will not be made public in any way. The materials submit will be reviewed by my program at National Louis University. This form is a request for your consent to include both your child in the video and his or her class work. Please complete the bottom half of this page and retain the top for your reference. If you have any questions about the use of this video or your child’s class work, please contact my NLU seminar leader, ], at or (email). (phone)
Thank you for your consideration.
Teacher Candidate Name:
Date:
RELEASE FORM FOR STUDENT PARTICIPATION Student’s name: Student’s school:
I am the parent or legal guardian of the child named above. I have read and understand the project description given in the letter provided at the top of this form, and agree to the following (please check the appropriate line below): I DO give permission for my child to appear on video recordings and my child’s class work to be used in the Teacher Performance Assessment of [ (Teacher candidate name]. I understand that my child’s name and any other personally identifiable information about my child will not appear on any of the submitted materials. I DO NOT give permission for my child to appear on video recordings and my child’s class work to be used in the Teacher Performance Assessment of [Student Teacher] and understand that my child will be seated outside of the recorded activities. Signature of Parent or Guardian: Date:
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ELE MAT P2/ST Handbook 2025-2026
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