Release Form for P-12 Student Participation Teacher Performance Assessment– and/or Approval for Videotaping of Teacher Candidates in Practicum/Student Teaching
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. As well, Illinois requires performance assessments of its teacher candidates. This means that to complete my student teaching assignment, I must complete a performance assessment called the Teacher Performance Assessment. This assessment includes submitting a video of me teaching a series of lessons in the classroom and examples of student work completed. While 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 always be kept confidential. The video recordings and student work I submit will not be made public in any way. Materials I submit will be reviewed by my program at National Louis University, and they may also be used by test developers under secure conditions for development and implementation, including scorer training. They may also be used for local evaluation by faculty 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 (phone) or (email). 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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ECE MAT P2/ST Handbook 2025-2026
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